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Biomedical subjects

D Goldberg

Publications and source records attributed to D Goldberg.

At least 253 records · Page 14Linked to original sources
PubMed1986

Results of a prospective randomized trial of continuous regional chemotherapy and hepatic resection as treatment of hepatic metastases from colorectal primaries.

One hundred patients were entered on a randomized prospective protocol to evaluate the effectiveness of hepatic resection of single as well as multiple hepatic metastases from colorectal primaries in combination with continuous hepatic artery infusion (CHAI) of fluorodeoxyuridine (FUDR) via the implantable pump (Infusaid, Intermedics Infusaid Inc., Norwood, MA). The eight patients with single metastases were randomized to hepatic resection alone (three patients) or hepatic resection plus CHAI (five patients). The 22 patients with resectable multiple metastases were randomized between receiving CHAI only (12) or CHAI after resection of all metastases (10). Patients who had positive portal lymph nodes (14) were all treated with CHAI. Patients with unresectable metastases (31) were randomized between intravenous 5-fluorouracil or CHAI of FUDR. FUDR was alternately infused every 2 weeks at a dose of 0.1 mg/kg/24 hour escalated to .3 mg/kg/24 hour with heparinized saline as the alternative infusate. The median follow-up of all patients was 20 months. All patients with multiple resectable metastases had at least a partial response (PR) to the CHAI (PR defined as greater than or equal to 50% decrease of the sum of the products of the diameters of the lesions measured on computerized axial tomography scans), and four patients given CHAI only had no metastases in the liver on relaparotomy. Patients with resection and CHAI had a better survival than patients with CHAI only; however, the difference was not significant. Patients with positive portal nodes and CHAI had a lower PR (36%) than patients with unresectable disease treated with CHAI (52%). Patients with positive portal nodes or metastatic disease outside of the liver did significantly worse than patients with unresectable disease treated with CHAI.

Clinical Trials as Topic↗
PubMed1986

Polymorphism of HLA-DR beta chains in DR4, -7, and -9 haplotypes: implications for the mechanisms of allelic variation.

We have isolated and sequenced cDNA clones corresponding to the DR beta 1 and DR beta 2 loci from two homozygous B-cell lines typed as DR7 (Burkhart) and DR9 (ISK). These nucleotide sequences were compared to beta 1 and beta 2 chains of other DR haplotypes. The first-domain sequences of beta 2 chains are identical in DR4 and DR7 haplotypes. In addition, there is strong sequence homology within the 3' untranslated regions of beta 1 genes from DR4, -7, and -9 haplotypes, thus confirming the close evolutionary relationship among these three haplotypes. In contrast, the first-domain sequences of beta 1 molecules from these haplotypes are very different from each other and do not reflect the DR4, -7, -9 family relationship. Two explanations for the differences in degree of diversity between beta 1 and beta 2 chains are suggested. The differences may be a consequence of selection pressures; this implies functional differences for products of the beta 1 and beta 2 loci. Alternatively, closely linked segments of the human class II region may differ in their underlying rates of variation, independent of selection pressures, and this may in part account for the extraordinary diversity found in the beta 1 first domain.

Alleles↗
PubMed1986

Molecular diversity of HLA-DR4 haplotypes.

Complementary DNA (cDNA) clones encoding beta chains of the DR and DQ regions and alpha chains of the DQ region were isolated and sequenced from four homozygous DR4 cell lines of different HLA-D types: GM3103(Dw4), FS(Dw10), BIN(Dw14), and KT3(Dw15). When compared with each other and with a previously published sequence from a DR4 (Dw13 cell line), the variability of DR beta 1 gene products is generally restricted to the region around amino acid position 70, with an additional polymorphism at position 86. Many of these differences, including an unusual amino acid substitution at position 57 in the Japanese cell line KT3(Dw15), may be due to gene conversion events from the DR beta 2 or DX beta genes. In contrast, DR beta 2 molecules are identical in Dw15, Dw10, and Dw4 cell lines. DQ beta chains isolated from GM3103(Dw4), FS(Dw10), and BIN40(Dw14) are also identical. However, the DQ beta sequence from cell line KT3(Dw15) differs substantially from all other previously reported DQ beta alleles, consistent with its serological designation, DQ "blank." The first domain sequences of DQ alpha chains were identical in all four cell lines. The data suggest that relatively circumscribed amino acid changes in the DR beta 1 molecule are responsible for the HLA-D typing differences between some haplotypes.

Base Sequence↗
PubMed1986

Teaching medical students about neurosis.

Practices used by medical schools in Great Britain and Ireland in the teaching of neurosis to medical students were assessed using postal questionnaires distributed to heads of departments, and to medical students at the end of their psychiatric attachments. In addition, medical students' factual knowledge about neurotic illnesses was measured using a brief multiple choice question (MCQ) test distributed with the questionnaire. There was considerable dissatisfaction among heads of departments with the way neurosis is taught, and there was general agreement that students see too many patients with psychotic illnesses and too few neurotics. Most neurotic patients are seen within departments of psychiatry and heads of department felt there was too little use of other settings such as general medical wards or general practice. Factual knowledge about neurosis as assessed by the MCQ was generally poor. Knowledge about neurotic illnesses relates most closely to the time devoted by departments to formal lectures on neurosis and is inversely related to the proportion of psychotic patients seen by students. Teaching of techniques of medical interviewing including the use of audio and video feedback of interviewing skills and behaviours is now widespread in British medical schools. There was no tendency for students receiving such teaching to display a better knowledge about neurosis.

Clinical Clerkship↗
PubMed1986

High-dose continuous infusion folinic acid and bolus 5-fluorouracil in patients with advanced colorectal cancer: a phase II study.

Encouraging results have recently been reported for studies using folinic acid in combination with 5-fluorouracil (5-FU) in the treatment of patients with gastrointestinal (GI) malignancies. Thirty-six patients with advanced colorectal cancer with unequivocal evidence of progression while treated with fluoropyrimidines were treated with a six-day continuous infusion of 500 mg/m2/d of folinic acid initiated 24 hours before a five-day course of 5-FU administered as an intravenous (IV) bolus of 370 mg/m2/d. An initial dose of 250 mg/m2/d of 5-FU was used in patients previously treated with ionizing radiation and/or a nitrosourea. Three objective partial responses were observed. The overall median duration of survival was 8.1 months. Toxicity was acceptable and not in excess of that expected for 5-FU alone.

Adult↗
PubMed1986

Erosive arthritis of the costovertebral joint in seronegative spondyloarthropathy.

A 50-year-old male presented with polyarthritis and pain of the right costovertebral angle in the cervicothoracic area. Radiological findings in a sacroiliac joint, the presence of a syndesmophyte, the HLA B-27 phenotype and negative serological studies prompted the diagnosis of HLA-B27 related seronegative spondyloarthropathy. Conventional and computerized tomograms disclosed an erosive arthritis of the 1st right costovertebral joint that was responsible for the pain in the costovertebral angle. We are unaware of previous CT scan documentation of such lesions.

Arthritis↗
PubMed1986

DERM/RX. A computer aid to the management of diseases of the skin.

DERM/RX (dermatologic therapy) is a computerized data base representing a compendium of therapeutic management options for over 600 diseases of the skin. This data base is housed in the National Headquarters of the American Academy of Dermatology in Evanston, Illinois. It is accessible via DERM/INFONET to members of the American Academy of Dermatology via telephonic communication lines that blanket the United States. The data base is constantly updated by the Task Force on DERM/RX of the Committee on Biomedical Communications of the American Academy of Dermatology.

Humans↗
PubMed1985

Cloned allospecific human helper T cell lines induce an MHC-restricted proliferative response by resting B cells.

To analyze helper T (Th) cell-induced B cell proliferation in man, we have cloned allospecific Th cells, grown them as long-term IL 2-dependent T cell lines (TCL), and analyzed their phenotypic and functional properties. The two TCL described in this report, A-7 and A-57, are both composed exclusively of T3+, T4+, T8- T cells blasts. In proliferative assays, with a panel of x-irradiated allogeneic stimulator cells, A-7 was found to proliferate in response to DR3-bearing cells, whereas A-57 responds to DR2-positive stimulators. Both TCL are capable of providing MHC-restricted polyclonal help for allogeneic B cells, as measured in the reverse hemolytic plaque assay. Of greater interest, x-irradiated A-7 and A-57 cells are capable of inducing a proliferative response by allogeneic B cells that is absolutely MHC restricted at the inductive (Th-APC) level. Thus, x-irradiated A-7 cells only trigger proliferation by DR3+ B cells, whereas A-57 cells selectively activate DR2+ B cells. In contrast, after antigen-specific activation, x-irradiated A-7 and A-57 cells can recruit a significant proliferative response by allogeneic B cells bearing "irrelevant" DR antigens. The possibility that Th-induced B cell proliferation may be restricted at the effector (Th-B cell) level was addressed by fractionating B cell populations into "activated" and "resting" subsets by discontinuous Percoll density gradient centrifugation and further purification by employing a monoclonal antibody directed against an antigen expressed on activated B cells (4F2). These studies demonstrate that activated B cells are readily and nonspecifically recruited to proliferate by activated Th cells, whereas optimal proliferative responses by resting B cells require MHC restricted Th-B cell interaction.

Antibodies, Monoclonal↗
PubMed1984

[Role of chemotherapy in the treatment of bone metastases of breast cancer].

This study was made on 98 patients with breast cancer, whose first discovered metastasis was to the bone, a mean of 2.8 years following the initial diagnosis. It is most often a lytic lesion, and the majority of patients have more than two areas on bone scintiscan. About half of the patients received palliative radiotherapy; 16 had to undergo surgery for or to prevent pathologic fractures. All patients underwent chemotherapy with vincristine or vinblastine, methotrexate or cyclophosphamide, 5-fluorouracil and, in 37 cases, the addition of adriamycin. Half of the patients also received tamoxifen. Present studies show a mean survival of 31 months with 24% survival at five years. Age, the interval to the discovery of the first metastasis, the use of additional chemotherapy following surgery for the breast lesion, the sedimentation rate, and the number of bony metastases do not play any prognostic role. However, the prognosis is significantly improved by adding tamoxifen, and even more so by adding adriamycin to the chemotherapeutic protocol since mean survival improves from 26 to 52 months. The reduced incidence of bony metastases with chemotherapy following surgery had led some authors to believe that prevention is the best method of treating bony metastases from breast cancer.

Adult↗
PubMed1984

Caries levels in patients with juvenile periodontitis.

The degree and distribution of tooth decay in a group of juvenile periodontitis ( JP ) patients were compared with tooth decay in an age- and sex-matched periodontally normal control group. The experimental group was comprised of 13 patients of no more than 20 years of age who were designated as localized juvenile periodontitis patients ( LJP ) according to the definition of Baer, and 10 patients of no more than 25 years of age who were designated as generalized juvenile periodontitis patients ( GJP ), as described by Manson and Lehner . Twenty-three age- and sex-matched patients with no periodontal disease served as the control group. Caries was evaluated by standard clinical and radiographic criteria and quantitated by decayed, missing, filled teeth and surfaces (DMFS). Decay was further categorized as active proximal decay and as total proximal decay, which included both active proximal caries and restored proximal surfaces. A Student's t test revealed no statistical differences between the LJP and GJP groups. Moreover, there was no difference in the number of missing or filled teeth in the JP group as compared to the control group. However, 17 of the 23 JP patients had no proximal decay, whereas all but two of the 23 control patients had some proximal decay. Moreover, in the JP group ( LJP and GJP ) the mean values for active proximal decay and total proximal decay were both significantly lower than those in the control group (P less than 0.001). Thus, a low number of proximal carious lesions were found in the presence of juvenile periodontitis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗