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Biomedical subjects

A Goldman

Publications and source records attributed to A Goldman.

At least 163 records · Page 9Linked to original sources
PubMed1987

Posterior fracture dislocation of the shoulder with biceps tendon interposition.

Posterior dislocation of the shoulder, a rare injury, results from direct trauma, indirect trauma, or via a seizure or electrical shock. We present a case with a posterior fracture dislocation of the shoulder secondary to a seizure in which interposition of the biceps tendon precluded closed reduction. The fractured lesser tuberosity fragment included the bicipital groove, allowing the biceps tendon to sublux posteriorly preventing closed reduction, thus requiring a subsequent open reduction.

Humans↗
PubMed1987

A posterior arthroscopic approach to bullet extraction from the hip.

A 22-year-old male sustained a gunshot injury to the left hip region. The bullet lodged in the articular surface of the femoral head posterosuperomedially. The location of the bullet within the hip joint stimulated the performance of an arthroscopy of the hip through a posterior approach. The authors are unaware of any other report in the literature describing such an approach. To minimize the dangers, a limited posterior incision was made and deepened through the short rotators. The arthroscope was introduced through the incision to perforate the posteroinferior portion of the hip joint capsule. The bullet was easily visualized with a 70 degree arthroscope. Positioning at the joint and traction are vital components to visualization. The use of three-dimensional CT scanning is an aid to the graphic understanding of the bullet's pathway and relations to the surfaces of the hip joint.

Adult↗
PubMed1987

Neurobehavioral functioning and magnetic resonance imaging findings in young boxers.

In a prospective investigation of neurobehavioral functioning in young boxers, 13 pugilists and 13 matched control subjects underwent tests of attention, information-processing rate, memory, and visuomotor coordination and speed. The results disclosed more proficient verbal learning in the control subjects, whereas delayed recall and other measurements of memory did not differ between the two groups. Reaction time was faster in the boxers than in the control subjects, but no other differences were significant. Ten subjects in each group were retested 6 months later and exhibited improvement in their neuropsychological performance as compared to baseline measurements. However, there were no differences in scores between the boxers and the control subjects at the follow-up examination or in the magnitude of improvement from baseline values. Magnetic resonance imaging, which was performed in nine of the boxers, disclosed normal findings.

Adult↗
PubMed1987

Positive effect of prophylactic total parenteral nutrition on long-term outcome of bone marrow transplantation.

In a randomized trial we studied the impact of providing total parenteral nutrition (TPN) to bone marrow transplant (BMT) patients during their cytoreductive therapy, and for 4 weeks following BMT, on 8 parameters of outcome. A total of 137 patients over 1 year of age and with normal nutritional status were randomized either to receive TPN starting one week prior to transplant or to receive hydration with a 5% dextrose solution containing electrolytes, minerals, trace elements, and vitamins. TPN was ultimately required by 40 of the 66 control patients when nutritional depletion was documented. Average total calorie and protein intake was significantly higher for the TPN group than for the control group. Minimum follow-up was 1 year and median was 2 years. Overall survival, time to relapse, and disease-free survival were significantly improved in the TPN group. Engraftment, duration of hospitalization, and incidences of acute and chronic graft-vs.-host disease and bacteremia were not different. Thus TPN during BMT had a positive effect on long-term outcome. Prophylactic nutritional therapy appears to be indicated even for well-nourished individuals during cytoreduction and BMT.

Bone Marrow Transplantation↗
PubMed1986

Needle catheter duodenostomy: a technique for duodenal alimentation of birds.

A technique for duodenal alimentation (needle catheter duodenostomy) of birds was developed, using the domestic pigeon (Columba livia) as the experimental model. A needle catheter was inserted into the descending duodenum of 5 pigeons and was secured to the body wall and dorsum of each bird. A liquid diet was administered daily (in equal amounts of 0, 4, 8, 12, and 16 hours) for 14 days without adverse effects. On day 15, the catheters were removed, and the birds immediately resumed normal consumption of a pigeon ration and water diet. Although 4 of the 5 birds had minor weight loss, dietary alterations probably could be used on an individual basis to alleviate this problem. After oral alimentation was resumed, the 5 birds exceeded their initial body weight within 7 days. Four weeks after catheter removal, positive-contrast radiographic evaluations indicated that the duodenum of each pigeon appeared normal. Needle catheter duodenostomy was a viable method of alimentation in the domestic pigeon. This technique should be applicable for other avian species requiring bypass of the upper gastrointestinal tract proximal to the region of catheter insertion in the duodenum.

Animals↗
PubMed1986

"Crossing balloons:" a new technique for complex angioplasty.

A new technique is described for complex percutaneous transluminal coronary angioplasty of a lesion at the bifurcation of the obtuse marginal branch of the left coronary artery, just distal to a venous bypass graft insertion. Two separate angioplasty guide wire and catheter systems were used and the coronary artery side branch was protected in a "crossing" manner.

Adult↗
PubMed1986

Cytomegalovirus infection after bone marrow transplantation: an association with acute graft-v-host disease.

Among 181 patients undergoing allogeneic bone marrow transplantation over a five-year period (1978 through 1982), cytomegalovirus (CMV) infection was a frequent and often lethal complication. Recipient pretransplant serology was the most important predictor of posttransplant CMV infection. CMV infection occurred in 26/137 seronegative recipients and in 28/44 seropositive recipients (P less than .001). Among patients who developed CMV infection, the time to infection was identical in seronegative and seropositive patients (median, 71 days post transplant). Bone marrow donor CMV serology did not significantly influence CMV infection rate. CMV infection was strongly associated with acute graft-v-host disease (AGVHD), occurring in 34/81 patients with AGVHD and 20/100 without GVHD (P less than .001). AGVHD preceded CMV infection by 33.7 days (mean) in patients developing both complications. Patients who developed CMV infections had also received more cellular blood products post transplant. These data suggest that CMV infection may occur through reactivation of latent virus (in seropositive recipients) or through exogenous exposure, possibly through transfused blood products, but that duration of immunoincompetence may be more critical than route of exposure in timing of clinically evident CMV infection. Prophylaxis tailored to the likely infectious source and more effective GVHD prevention both may be critical in preventing CMV infection after bone marrow transplantation.

Acute Disease↗
PubMed1986

Noninvasive evaluation of cardiac valve prostheses.

Noninvasive techniques are particularly helpful in evaluating the function of mechanical prostheses and tissue valves. Combined phonocardiography with M-mode echocardiography, cinefluoroscopy, and Doppler echocardiography are the most useful noninvasive techniques in differentiating normal from abnormal metallic prosthetic valve function. The intensity of the opening and closing clicks and associated murmurs will depend on the type of prosthetic valve, the heart rate and rhythm, and the underlying hemodynamic status. Arrhythmias and/or conduction disturbances may produce motion patterns that mimic the echocardiographic signs of malfunctioning prosthetic valves. Two-dimensional echocardiography is of limited help in assessing patients with metallic prosthetic valves because of reverberating artifacts and side lobe echoes. However, 2-D echo is extremely useful in excluding underlying left ventricular dysfunction. In addition, 2-D echo allows the determination of the precise alignment of the prosthetic valves so that optimal M-mode evaluation of the disc or poppet motion can be undertaken. Two-dimensional echocardiography also allows diagnosis of pericardial effusion and exclusion of other valvular abnormalities. Differentiation of thrombus formation or tissue ingrowth from paravalvular regurgitation or dehiscence is possible by echophonocardiography, Doppler echocardiography, and cinefluoroscopy. Doppler echocardiography is the most sensitive noninvasive technique in diagnosing paravalvular leaks. In addition, significant obstruction across a prosthetic valve can be determined by calculation of maximal gradient across the obstructed orifice using Doppler echocardiography. The differentiation between "benign physiological regurgitation" from true "pathological regurgitation" by Doppler is not always possible. Disc variance is a potentially serious and lethal problem with the older Beall valves and can be detected readily by a combination of echophonocardiography, cinefluoroscopy, and Doppler echocardiography. With regard to bioprosthetic valves, 2-D echo is superior to M-mode in detecting primary valve failure. In addition, detection of vegetations, valve alignment, ring and individual leaflet motion can be readily accomplished by 2-D echo. When considering the value of noninvasive techniques in prosthetic valve function, it is essential to recognize that the patients must serve as their own control in the follow-up assessment.

Arrhythmias, Cardiac↗
PubMed1985

A randomized trial of chemotherapy and hormonal therapy in advanced breast cancer.

We randomized 81 postmenopausal women with advanced breast cancer, whose tumors were rich in estrogen receptors or of unknown estrogen-receptor status, to receive either estrogen therapy alone or estrogen therapy combined with chemotherapy. An additional 31 patients, whose tumors were poor in estrogen receptors, were randomized to receive either chemotherapy alone or estrogen combined with chemotherapy. The median duration of follow-up was 87 months. In the receptor-rich group, the survival of the 21 patients receiving combined therapy was significantly longer than that of 19 patients receiving estrogen as initial therapy (followed by chemotherapy after failure or relapse). The median survivals were 72 and 29 months, respectively (P = 0.05 by the generalized Wilcoxon method). Among 41 patients with tumors of unknown receptor status, a survival advantage from combined therapy over chemotherapy was seen in the first two years and then disappeared. The survival in 31 patients with receptor-poor tumors was uniformly short regardless of the therapeutic method. We conclude that combined therapy offers a survival advantage in postmenopausal patients with receptor-rich tumors.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1985

Therapeutic application of a radiolabelled monoclonal antibody in nude mice xenografted with human neuroblastoma: tumoricidal effects and distribution studies.

Monoclonal antibody UJ13A radiolabelled with isotopes of iodine has been shown to selectively localize to human neuroblastoma xenografts. When 131I-UJ13A conjugates were given to nude mice at high doses (100-150 microCi), tumours temporarily disappeared, only to regrow. No selection for neuroblastoma cells that were UJ13A - negative was observed. Distribution studies on mice receiving radiolabelled UJ13A demonstrated the antibody is rapidly lost from the blood of animals. This cannot be accounted for by selective uptake into xenografts or any other mouse organ examined. We concluded there is a rapid equilibration of isotope between intra- and extravascular spaces in the animal. The rapid, biphasic loss of UJ13A from the blood of mice may explain why so little injected antibody can target to the human tumour xenografts.

Animals↗
PubMed1985

Crystal structure of muconate lactonizing enzyme at 6.5 A resolution.

We have obtained crystals of Pseudomonas putida muconate lactonizing enzyme. They diffract to better than 2.4 A resolution and have two monomers in the asymmetric unit, related by a non-crystallographic 2-fold axis. The cell dimensions are 139.3 A X 139.3 A X 84.1 A, and the space group is I4. The electron density map at 6.5 A resolution shows that the enzyme is an octamer with D4 symmetry.

Crystallography↗
PubMed1985

Nocturnal penile tumescence and penile responses in the waking state in diabetic and nondiabetic sexual dysfunctionals.

This study compared diabetics with sexual dysfunction, nondiabetics with sexual dysfunction, and a group of controls on nocturnal penile tumescence (NPT) during three nights in a sleep laboratory, and penile response to erotic stimulation in the waking state on one of the nights. Both diabetic and nondiabetic dysfunctionals showed less erectile response to erotic films and tape than controls but did not differ from each other. In contrast, the diabetic dysfunctionals showed significantly weaker NPT response than both the nondiabetic dysfunctionals and the controls, and 58% of them (contrasted with 23% of nondiabetic dysfunctionals and 0% of controls) would be classified as organic using minimal NPT (less than 11.5 mm maximal increase in penile circumference during any nocturnal erection) as the sole criterion. There was a significant relationship between NPT and waking erections in response to erotic stimuli, especially in the diabetic dysfunctionals and the controls.

Adult↗
PubMed1985

Treatment of acute idiopathic thrombocytopenia of childhood with intravenous infusions of gammaglobulin.

Gammaglobulin treatment was given at a dose of 1 gm/kg/day intravenously in 29 patients with acute idiopathic thrombocytopenic purpura: 15 previously untreated, 10 resistant to steroids, and four who were steroid dependent. The average platelet increase in 24 hours was greater than 50,000/microliter; the average peak platelet count was 194,000/microliter. Eighteen of 25 patients required only one infusion; 10 of these 18 never required any additional (maintenance) therapy. Outcome in previously untreated and steroid-resistant patients was identical; however, previously untreated patients required only 1.8 gm/kg total dose of gammaglobulin, whereas steroid-resistant patients received 3.9 gm/kg. Only one steroid-dependent child of the 29 patients still requires maintenance therapy, at 6-week intervals. Toxicity was minimal. Cost was minimized by not admitting patients and by giving treatment in one visit, rather than five.

Acute Disease↗
PubMed1985

Graft-versus-host disease prophylaxis with anti-T-cell monoclonal antibody OKT3, prednisone and methotrexate in allogeneic bone-marrow transplantation.

A new regimen for prevention of acute graft-versus-host disease (GvHD)--OKT3 (murine monoclonal anti-pan-T antibody), prednisone and methotrexate (OKT3-pred-MTX)--was compared with the Minnesota standard regimen--antithymocyte globulin, prednisone and methotrexate (ATG-pred-MTX)--for adverse effects, effect on incidence of acute GvHD, and survival at 1 year post-transplant. Twenty patients (aged 25 +/- 9 years) had bone-marrow transplantation (BMT) from their HLA-MLC identical sibling donors for treatment of aplastic anaemia (four), acute leukaemia in remission (13) or chronic myelogenous leukaemia (three). These 20 patients received (OKT3-pred-MTX) on days 8-22 post-transplant. Results of this group are compared to those of 19 concurrent patients (aged 26 +/- 12 years) who received ATG-pred-MTX on days 8-22 post-transplant. On the first day of treatment, 20/20 OKT3 patients and 18/19 ATG patients were febrile. Within 24 h of the first dose of OKT3, 6/20 patients experienced dyspnoea or chest pain and 3/20 patients developed diarrhoea. No further adverse effects were seen after the second dose of OKT3 and no late adverse effects were attributed to this drug. Time to engraftment (means 25 d) was not statistically significantly different in the two prophylactic groups. Acute GvHD was diagnosed in 14 of 20 patients who received OKT3-pred-MTX and in eight of 19 patients who received ATG-pred-MTX (P = 0.06). The incidence of hepatic or gastrointestinal GVHD (greater than or equal to grade 2) was similar in the two groups: 4/20 OKT3-pred-MTX, 6/19 ATG-pred-MTX. Characteristics of post-transplant infections were also similar for the two prophylactic groups. Survival at 1 year post-transplant was 65% for patients who received OKT3 and 44% for patients who received ATG (P = 0.13). The use of OKT3 with prednisone and methotrexate is relatively safe and is associated with a similar incidence of moderate-severe acute GvHD to that experienced in the use of ATG with prednisone and methotrexate.

Adolescent↗