Biomedical subjects
Publications and source records attributed to E M Gold.
The three distinct etiologies of Cushing's syndrome usually reflect the presence of a neoplasm, most often but not necessarily of the pituitary, and all ultimately result in hypercortisolism. Recent advances in diagnosis and treatment have vastly improved the outlook for many patients. Several therapeutic options are outlined, the success of which depends on accurate identification of the cause of hypercortisolism.
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Cushing's syndrome is the common clinical presentation of three unique disorders that give rise to hypercortisolism. In most cases neoplasms underly each of these disorders. Clinical features are highly variable and not accounted for by cortisol alone; indeed, the multihormonal basis for much of the clinical syndrome remains uncertain. Demonstration of sustained, excessive cortisol production is essential and depends on a pattern of repeated measurements and several different procedures. Plasma adrenocorticotropin, although not helpful in establishing the diagnosis, has proved valuable in differentiating the three major entities that cause hypercortisolism. The renewed significance of pituitary microadenomas and their improved detection by sella tomography has accompanied recent, impressive advances in transsphenoidal microsurgery. This may become the preferred treatment for pituitary Cushing's syndrome in the adult, particularly where the appropriate equipment and skills are available; for children, external pituitary irradiation seems to offer safe and effective therapy.
One hundred and twenty-six sexual assault victims were examined and treated at the Women and Infants Hospital of Rhode Island from July 1 1976, through June 30, 1977. Sixty-six were less than 18 years of age, and of this group, 54 were less than 16 years of age, and 26 of these were prepubertal. Evidentiary examination was performed on 100 victims. No pregnancies resulted, and no victim acquired syphilis from the assault. Five patients had positive cultures for gonorrhea at the time of initial examination and all were cured by therapy. Epidemiologic correlates of sexual assault are discussed.
Pituitary disorders can be diagnosed more readily and precisely as a result of two recent advances: development of radioimmunoassays for direct measurement of each pituitary hormone in blood, and availability of hypothalamic hormones for use in provocative tests for secretion of thyroid-stimulating hormone, prolactin, and gonadotropic hormones.
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An 11-year study from January 1, 1965, through December 31, 1975, was undertaken to study maternal death associated with cesarean section in Rhode Island. The risk of maternal death associated with cesarean section and that for vaginal delivery was calculated, and it was found that the risk of death from cesarean section was 26 times greater than with vaginal delivery. The expanding indications for cesarean section, factors associated with excess risk of death from cesarean section, and suggestions to prevent such catastrophe are discussed.
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Explore the source record for details and available documents.