Search PubMed⌕ Search

Biomedical subjects

G Goldsmith

Publications and source records attributed to G Goldsmith.

At least 19 recordsLinked to original sources
PubMed1998

Treatment of acute immune thrombocytopenic purpura.

Medical history, physical examination, and laboratory testing are essential to arriving at the diagnosis of acute immune thrombocytopenic purpura (ITP). A history of recent viral illness occurs in about half of the pediatric patients who present with acute symptoms of ITP. The physical examination is normal except for purpura; a complete blood cell count with a differential white blood cell count can be used to confirm the diagnosis of acute ITP. Treatment decisions for acute ITP remain controversial. Treatment generally is designed to prevent life-threatening complications, such as intracranial hemorrhage, and may include single or combination therapy with corticosteroids, intravenous immunoglobulin (IVIg), anti-D, and splenectomy. Corticosteroids are inexpensive and offer an alluring option, especially in the recent era of cost-containment. The often slow platelet response and the potentially severe adverse effects of corticosteroid therapy are frequently a deterrent. IVIg usually leads to a rapid rise in platelet count; however, IVIg is very expensive and adverse effects associated with its infusion are common and sometimes troublesome. The role of anti-D in acute ITP is still evolving. It is similar to IVIg in platelet response and is considerably less expensive. Some degree of hemolysis, the main adverse reaction with anti-D, is inevitable due to the binding of anti-D antibody to Rh-positive erythrocytes. However, most cases of hemolysis do not require medical intervention. Splenectomy is reserved for refractory thrombocytopenia with life-threatening hemorrhage in acute ITP or after recurrent severe thrombocytopenia in chronic ITP. Other immunomodulatory therapies are also discussed.

Acute Disease↗
PubMed1996

Safety and efficacy of purified factor IX concentrate and antifibrinolytic agents for dental extractions in hemophilia B.

This study evaluated the safety and efficacy of combined treatment with epsilon-aminocaproic acid or tranexamic acid and monoclonal antibody purified factor IX (MAb factor IX) for prophylaxis against bleeding in eight hemophilia B patients undergoing nine dental extraction procedures. All patients achieved excellent hemostasis without clinical evidence of thrombosis. There were no significant changes in hemoglobin or hematocrit or in markers of hemostatic system activation (prothrombin fragment F1+2, fibrinopeptide A, and fragment B beta 15-42) after surgery. Thus, a highly purified factor IX concentrate and antifibrinolytic therapy can be effectively and safely combined in hemophilia B patients undergoing dental extractions.

Adult↗
PubMed1993

Human neutrophil adhesion to bovine aortic endothelium. Evidence for endothelial lipoxygenase activity.

We examined the effect of phorbol myristate acetate on cultured bovine aortic endothelial cells to determine the role of endothelial cells in neutrophil-endothelial cell adhesive interactions. Confluent endothelial cells were preincubated with phorbol myristate acetate and other inflammatory signals including N-formylmethionyl-leucyl-phenylalanine (f-Met-Leu-Phe), the ionophore A23187, and thrombin; washed extensively; and incubated with 51Cr-labeled neutrophils. Preincubation of endothelium with A23187, phorbol ester, or thrombin increased adherence of neutrophils by 3.1-, 5.7-, and 3.7-fold over baseline. In contrast, f-Met-Leu-Phe preincubation failed to increase adhesion over baseline. Supernatants from endothelium preincubated with phorbol failed to augment adherence of untreated endothelial cells. Preincubation of endothelium with lipoxygenase inhibitors nordihydroguaiaretic acid (50 microM), 5,8,11,14-eicosatetraenoic acid (50 microM), and BW755C (50 microM) inhibited the effect of phorbol preincubation of endothelium significantly by 55, 27, and 22%, respectively. In contrast, inhibitors of cyclooxygenase and thromboxane synthase or thromboxane receptor antagonists had no effect on phorbol-induced adhesion. Specific desensitization of neutrophil adhesion to phorbol-treated endothelium could be demonstrated by prior exposure of neutrophils to low concentrations of leukotriene B4 (3.8 x 10(-10) M). Endothelium preincubated with phorbol but not f-Met-Leu-Phe or thrombin produced several fatty acid peaks at 280 nm, one of which comigrated with authentic leukotriene B4 (LTB4). This peak, isolated and purified, increased endothelial cell adherence in a temporal fashion in the same way as LTB4 and was demonstrated to be LTB4 by ultraviolet spectroscopy, high-performance liquid chromatography, and mass spectroscopy. These data demonstrate that endothelial cell-derived lipoxygenase metabolites, in particular LTB4, are involved, in part, in the acute regulation of neutrophil adhesion to endothelium induced by inflammatory signals such as phorbol ester.

Animals↗
PubMed1993

Effect of sleep quality on symptoms of irritable bowel syndrome.

A prospective, one-month diary study was conducted with 23 adult irritable bowel syndrome (IBS) patients in order to determine the relationship between IBS and the quality of sleep. Subjects were screened through history and diagnostic studies. Accepted patients then completed a daily diary of IBS symptoms and sleep quality. At baseline, most subjects (74%) characterized themselves as "poor sleepers." Using pooled time series analysis, the study found a significant correlation between morning IBS symptoms and the quality of the prior night's sleep (P < 0.001), a finding not previously reported in the literature. A less strong but still significant correlation (P < 0.05) was found between end of day IBS symptoms and the quality of sleep during the prior evening. Morning IBS symptoms seem to rise or fall in close association with the prior night's quality of sleep. The study supports the hypothesis that IBS symptoms are related to a disturbance in sleep.

Adult↗
PubMed1993

Are immunoglobulins with lupus anticoagulant activity specific for phospholipids?

Recent studies have suggested that the lupus anticoagulant (LA) may be specific for prothrombin, prothrombin-phospholipid complexes, or beta 2 glycoprotein 1 (beta 2GP1) rather than phospholipids. We performed a series of experiments to determine whether LA is indeed phospholipid specific. IgG was purified from sera of six patients with the antiphospholipid syndrome (APS) and 10 healthy controls. The six IgG-APS preparations had both LA and anticardiolipin (aCL) activity. Incubation of the six IgG-APS preparations with cardiolipin (CL), phosphatidylserine (PS), phosphatidylcholine (PC), or PS/PC (20:80) liposomes in Tris-buffered saline, resulted in loss of LA activity from the supernatant. We postulated that loss of activity might have resulted from absorption of IgG LA antibodies by phospholipids, a dilutional effect, or the presence of phospholipids in the supernatant causing 'by-pass' of IgG LA inhibitory activity. To distinguish between these possibilities, we re-isolated IgG from the supernatants and re-tested them for LA activity. IgG re-isolated from the PS. CL and PS/PC supernatants had no LA activity, but LA activity remained in the PC supernatant. This suggested that IgG with LA activity was absorbed by negatively charged but not by zwitterionic phospholipids. In like manner, PS, CL and PS/PC, but not PC liposomes, absorbed IgG with aCL activity. Mixtures of the phospholipid liposomes with beta 2GP1 did not modify the absorption of IgG with LA or aCL activity. Finally, we demonstrated that IgG eluted from immunoglobulin-cardiolipin liposome complexes had LA activity. Based on these findings, we conclude that at least one population of antibodies with LA activity is phospholipid specific.

Antibodies, Anticardiolipin↗
PubMed1993

Addressing Arkansas' rural primary care challenges.

Universal health coverage may become a reality by the year 2000 and implies a greater need for primary care physicians in rural Arkansas in the 21st century. We can start this decade to build the capacity for an outstanding rural primary care system for the next century. The number of rural primary care physicians can be increased by 1) placing a high priority on recruiting more students to primary care, 2) improving the attractiveness of rural practice, and 3) improving the long-term financial viability of rural primary care. The quality of rural primary care will be greatly influenced by changes in information technology. Medical outreach activities from urban centers to rural communities and changes in rural medical infrastructures will be necessary as we approach the year 2000.

Area Health Education Centers↗
PubMed1989

Stimulation-dependent release of adenosine triphosphate from hippocampal slices.

Schaffer collaterals of rat and mouse hippocampal slices were stimulated with bursts of pulses (300 Hz for 50 ms, 2-s intervals) for 30-s which caused a stable increase in the size of the population spike known as long-term potentiation. The release of adenosine triphosphate (ATP) was measured with a luciferase-luciferine system and the light emitted was recorded with a photomultiplier placed beneath a modified slice chamber. ATP release was observed shortly after the start of stimulation and was quantified by comparison with the response of standard solutions of ATP. No ATP release was observed in a Ca2+ free solution or after low frequency stimulation (1 Hz). Glutamate (2 mM), applied without electrical stimulation, did not evoke ATP release. Also, the glutamate receptor blocker, kynurenic acid (10 mM), did not block ATP release. It is concluded that ATP is released from electrically stimulated hippocampal slices from presynaptic nerve terminals in a calcium-dependent fashion and may play a role in the modulation of synaptic efficiency.

Action Potentials↗
PubMed1986

Evidence for a role of 5-hydroxytryptamine in the responses of rat raphe magnus neurones to peripheral noxious stimuli.

The role of serotoninergic mechanisms in the responses of neurones in the nucleus raphe magnus to peripheral noxious stimuli was investigated in rats anaesthetized with halothane. In normal animals a large proportion of neurones responded to peripheral noxious stimuli with excitation or inhibition, the direction of the response being dependent on the spontaneous activity of the neurone. Pretreatment with p-chlorophenylalanine (pCPA; 300 mg/kg X 3 days) led to a marked reduction in the number of cells responding to peripheral stimuli. Similarly, the injection of metergoline (5 mg/kg, i.v.) in normal animals caused a reduction in the magnitude of the neuronal responses to noxious stimuli. The results are discussed with regard to the role of serotoninergic mechanisms in the control of nociceptive transmission by this nucleus.

Animals↗
PubMed1986

Social functioning in chronic pain patients.

Although investigators have explored the effects of chronic illnesses on social functioning during the course of treatment, much less is known about the impact of treatment outcome on social functioning. In this study we examine whether the outcome of treatment for chronic pain in a pain clinic exerts a significant effect on the eventual social functioning. The findings indicate that a more favorable outcome is associated with increased marital satisfaction, a heightened desire for sex, and an increased desire and ability for recreational activities. These findings have implications for family practitioners as they assess social functioning after treatment for chronic pain.

Chronic Disease↗
PubMed1985

Irritable bowel syndrome: treatment update.

Patients with irritable bowel syndrome may be classified as "psychologic reactors," "food reactors" or "mixed reactors." The management approach is tailored to the reactive pattern. Education and reassurance are paramount in the management of irritable bowel syndrome. Psychologic reactors may benefit from antidepressant therapy, psychotherapy, relaxation training and biofeedback. Eliminating offending foods from the diet may provide relief in food reactors. Regular exercise may be especially salutary in patients with constipation.

Colonic Diseases, Functional↗
PubMed1982

Family practice.

Explore the source record for details and available documents.

Faculty, Medical↗
PubMed1982

Factors influencing family practice residency selection: a national survey.

The changes in family practice residency selection from 1978 to 1981 were studied by means of a questionnaire, and selection of family practice residency was identified by region. The relationship between the administrative status of family practice (department, division, or no formal unit) and selection of family practice residency was studied, and the opinions of medical school faculty respondents were sought concerning why interest in family practice has increased (or decreased) at their institution. The average percentage of graduates selecting family practice residency varies by region. Schools with stronger institutional commitment to family practice, as evidenced by departmental status, have a higher percentage of graduates entering family practice. Respondents felt that the presence or absence of student contact with family practice was the most important reason for changes seen in residency choice.

Career Choice↗