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Biomedical subjects

A Goldberg

Publications and source records attributed to A Goldberg.

At least 73 records · Page 4Linked to original sources
PubMed1997

Unilateral Meesmann's dystrophy.

We report the first case of a unilateral microcystic Meesmann's epithelial dystrophy, observed in the left cornea of a 43-year-old patient. The diagnosis was verified histologically by the unilateral occurrence of a 'peculiar substance' within epithelial cysts and within the cytoplasm of the corneal epithelial cells. In an attempt to resolve the patient's frequent corneal erosions, we performed an autologous stem cell transplantation from the non-involved right eye. The results are, so far, satisfactory.

Adult↗
PubMed1997

Three forms of meaning and their psychoanalytic significance.

The existence of three distinct forms of meaning--unearthed, reshaped, and improvised--is claimed to be a part of every analysis. These forms are defined and distinguished from one another. Each is presented as conforming to a certain set to psychological needs in the patient and so as having no overall or general significance as to its propriety vis-à-vis the others. As a group these meanings necessarily alter the concept of neutrality, rendering it relative to the individual patient.

Humans↗
PubMed1996

Trisomies 9 and 8 detected by fluorescence in situ hybridization in patients with systemic mastocytosis.

BACKGROUND: Systemic mastocytosis is a rare disease characterized by proliferation of mast cells in one or more organs. The origin of the mast cells is still debated, although it has been recently shown that they derive from CD34+ hematopoietic progenitors. Some clinical and in vitro studies have suggested a possible link between myeloproliferative disorders and systemic mast cell disease. OBJECTIVE: This study was designed to further evaluate the association between systemic mast cell disease and other hematologic disorders by means of conventional cytogenetic analysis and fluorescent in situ hybridization. METHODS: We used cytogenetic analysis and fluorescent in situ hybridization with probes to chromosomes 8 and 9 in six patients with systemic mast cell disease. RESULTS: Fluorescent in situ hybridization helped to identify five patients with trisomy 9 and one with trisomy 8. In contrast, chromosomal analysis demonstrated an abnormal karyotype (45,XO/46,XY) in only one patient. CONCLUSION: The association between myeloproliferation disorders and systemic mast cell disease may be explained by the finding that trisomy 9 and trisomy 8 are common in both disorders. A trisomy was detected in all of the patients in our small group compared with nearly 40% of previously reported patients with myeloproliferative disorders. FISH is more sensitive than conventional cytogenetics in detecting these aberrations.

Adult↗
PubMed1996

A multicenter double-blind study of controlled-release physostigmine for the treatment of symptoms secondary to Alzheimer's disease. Physostigmine Study Group.

OBJECTIVE: A multicenter trial to evaluate the efficacy of controlled-release physostigmine salicylate, a cholinesterase inhibitor, was conducted in 1,111 mild-to-moderate Alzheimer's disease (AD) subjects. DESIGN: During dose titration, subjects received 18, 24, or 30 mg of physostigmine or placebo daily. After a 2-week washout period, 366 subjects with putative improvement were randomized to receive either placebo or their best dose of physostigmine in a 6-week double-blind trial. Nonresponding patients (439) were randomized to receive in a separate double-blind trial either placebo or their highest tolerated dose of physostigmine. The primary efficacy measures included the cognitive subscale of the Alzheimer Disease Assessment Scale (ADAS) and a Clinical Global Impression of Change (CGIC). Secondary measures included the Mini-Mental State Examination and two activities-of-daily-living scales. RESULTS: At the end of the 6-week double-blind phase, physostigmine-treated patients scored 1.75 points higher than placebo-treated patients on the ADAS (p = 0.003) and 0.26 points higher on the CGIC (p = 0.012) in the intent-to-treat analysis. There was no significant improvement on the secondary outcome measures. Patients failing to respond to physostigmine during the dose titration phase failed to respond on any of the outcome measures during the double-blind period of re-exposure. Common adverse events included nausea, vomiting, diarrhea, and anorexia. There were no significant changes in liver function tests. CONCLUSION: This study demonstrated statistically significant differences between physostigmine and placebo on both a performance-based cognitive functioning instrument and a clinician's global evaluation. The magnitude of the effect size was small and occurred only in the subset of patients who responded in the initial dose titration study period. Nevertheless, the results suggest that in a subset of patients, physostigmine can induce a degree of cognitive improvement over 6 weeks of treatment.

Aged↗
PubMed1995

Human heart-infiltrating T-cell clones from rheumatic heart disease patients recognize both streptococcal and cardiac proteins.

BACKGROUND: beta-Hemolytic streptococcal infection in developing countries still causes thousands of causes of rheumatic heart disease, demanding surgical valve correction. Antigenic mimicry between self and streptococcal components has been proposed as the triggering factor leading to autoimmunity in individuals with genetic susceptibility. Although heart streptococcal-M protein cross-reactive antibodies have been demonstrated, heart tissue damage seems to be T lymphocyte-dependent. We studied the infiltrating T lymphocytes in rheumatic heart lesions with the aim of understanding the role of cellular immune response at the site of the lesions. METHODS AND RESULTS: We obtained 107 T-cell clones from surgical fragments of cardiac tissue from four rheumatic heart disease patients. We tested their capacity to recognize streptococcal M protein-derived synthetic peptides and heart proteins. We found eight infiltrating T-cell clones from all four patients that simultaneously recognize streptococcal M and heart proteins. Among the M-protein sequences tested, only synthetic peptides corresponding to regions 1 through 25, 81 through 103, and 163 through 177 were simultaneously recognized with heart protein fractions. Interestingly, regions 81 through 103 and 163 through 177 have been known to bear heart cross-reactive epitopes at the antibody level. Five of these clones are CD4+, and one is CD8+. CONCLUSIONS: The presence of heart-M protein cross-reactive T-cell clones in rheumatic heart lesions suggests their direct involvement in the pathogenesis of this disease. The dissection of protective and pathogenic epitopes of streptococcal M protein is an important step in allowing the development of a safe anti-streptococcal synthetic vaccine.

Amino Acid Sequence↗
PubMed1995

Changes in serum lipoprotein(a) in hyperlipidemic subjects undergoing long-term treatment with lipid-lowering drugs.

Though the exact physiology and pathology of lipoprotein(a) [Lp(a)] remains unknown, it has been demonstrated that increased serum Lp(a) levels are correlated with an increased risk of atherosclerotic vascular disease. The effects of lipid-lowering drugs on Lp(a) levels is unclear because of inconsistencies between study designs. This study analyzes the effects of the commonly used lipid-lowering drugs pravastatin (PRAV), lovastatin (LOV), and cholestyramine (CHOL) on serum Lp(a) and other serum lipid levels in a parallel study design. Hyperlipidemic men (n = 32) were enrolled from three centers and treated for 48 weeks in a multicenter clinical trial using PRAV, LOV, CHOL, or a placebo (for the first 16 weeks only). Baseline serum low-density lipoproteins (LDL-C), high-density lipoproteins (HDL-C), and triglycerides were 199 +/- 38, 40 +/- 9, and 160 +/- 70 mg/dl, respectively. At the end of 48 weeks, serum plasma LDL-C declined in patients randomized to PRAV, LOV, and CHOL, respectively, by 31%, 29%, and 23% (all p < 0.001); HDL increased by 4%, 11%, and 11% (all p < 0.001); and TG changed by -16%, -28%, and +43% (all p < 0.001). Subjects in PRAV and LOV changed Lp(a) by 9% and 3%, respectively. Although there was an initial Lp(a) decline in the first 8 weeks of CHOL therapy (p < 0.05, ANOVA), this returned to baseline after 48 weeks. In this parallel study design PRAV, LOV, and CHOL are effective LDL-lowering medications with minimal effects on plasma Lp(a).

Adult↗
PubMed1995

Clamp control of the right ventricular angle to facilitate exposure and repair of cardiac wounds.

Penetrating cardiac wounds, especially those of the posterior surface, present a major challenge to the trauma surgeon. Previously described methods to assist in cardiac exposure include manual control and apex stitch. The authors describe a simple technique to facilitate exposure during acute control and repair of traumatic cardiac wounds. Using an atraumatic vascular clamp in the fashion described allows for improved exposure and easier repair of heart surface wounds.

Cardiac Surgical Procedures↗
PubMed1995

Deliberate hymenoptera sting challenge as a diagnostic tool in highly selected venom-allergic patients.

BACKGROUND: Open environment and working conditions close to abundant insects of the order Hymenoptera should be avoided as much as possible by patients allergic to Hymenoptera venom who do not receive venom immunotherapy. After having experienced accidental field re-stings not resulting in a systemic reaction, some of these patients may be willing to resume normal life and working habits. Since venom-specific IgE usually remains elevated in these patients, repeated skin tests or RASTs are not helpful in identifying disappearance of their venom allergy. OBJECTIVE: The purpose of this study was to evaluate the usefulness of deliberate live sting challenge as a diagnostic tool in highly selected venom-allergic patients who had initially refused venom immunotherapy. METHODS: Two cases are reported of bee venom-allergic patients who had previously refused venom immunotherapy and subsequently experienced honeybee field re-stings not resulting in systemic reactions. Two to three years later, their skin tests remained positive for bee venom. A third patient allergic to Vespa orientalis who had negative skin tests to all available venoms was denied venom immunotherapy due to lack of proper commercial venom. Because none of the patients was receiving venom immunotherapy the military service personnel concluded they still had venom allergy and rejected them from the highly prestigious service. All three patients were anxious to confirm the disappearance of their venom allergy and we used deliberate live sting challenges for that purpose. RESULTS: Two to three years after their initial systemic reactions live sting challenges were well tolerated by the three patients. They felt free to resume their normal life habits and were allowed to begin military service without further limitations. CONCLUSION: Deliberate insect stings using appropriate safety precautions should be considered a diagnostic tool in selected allergic patients who do not receive venom immunotherapy but in whom a reliable history of negative field re-stings can be obtained despite positive skin tests and in those who continue to have inconclusive venom skin tests.

Adolescent↗
PubMed1995

Efficacy and safety of losartan.

Losartan potassium (losartan) is the first of a new class of antihypertensive agents that specifically blocks the type 1 angiotensin II receptor. The efficacy and safety of losartan have been assessed in double-blind, controlled clinical trials conducted in approximately 3700 patients with uncomplicated mild, moderate and severe essential hypertension. Overall, losartan, whether administered alone or in combination with a low dose of hydrochlorothiazide (HCTZ), was effective and well-tolerated in these clinical trials, with an incidence of adverse experiences similar to that of placebo. The antihypertensive effects of losartan 50 mg once daily were similar to those of 20 mg once daily of the angiotensin-converting enzyme (ACE) inhibitor enalapril. The antihypertensive effects of losartan 50 to 100 mg once daily were similar to those of the calcium channel blocker felodipine 5 to 10 mg and to those of the beta-adrenergic blocker atenolol 50 to 100 mg once daily. Losartan was shown to have a smooth antihypertensive profile throughout the 24 h period following dosing, which mirrors the diurnal variability of blood pressure. The addition of 12.5 mg HCTZ to 50 mg losartan produced an additional significant antihypertensive response. There were no clinically meaningful differences in the antihypertensive effect of losartan when assessed by demographic subgroups of age or sex; there is a smaller antihypertensive response in Black patients. The most common patient-reported, drug-related, clinical adverse experience, with an incidence greater than that of placebo, was dizziness (2.4% versus 1.3%). The overall rate of patient withdrawal from losartan therapy due to clinical adverse experiences was lower than that of placebo (2.3% versus 3.7%).(ABSTRACT TRUNCATED AT 250 WORDS)

Antihypertensive Agents↗
PubMed1995

Prolonged generalized pruritus associated with selective elevation of IgA as the presenting symptoms of sarcoidosis.

OBJECTIVE: The purpose of this case report is to describe the possible initial presentation of sarcoidosis as generalized prolonged pruritus. METHODS: In a patient presenting with prolonged generalized pruritus who also had selective elevation of IgA, the diagnosis of sarcoidosis was confirmed by bilateral interstitial infiltrates on chest radiograph, elevated angiotensin-converting enzyme, and dermal granuloma on skin biopsy from a recent rash. CONCLUSION: Sarcoidosis should be added to the list of diseases associated with prolonged pruritus and routine chest radiographs should be obtained in these patients.

Granuloma↗