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Biomedical subjects

H Goldman

Publications and source records attributed to H Goldman.

At least 91 records · Page 5Linked to original sources
PubMed1989

Effects of infection by HIV-1, cytomegalovirus, and human measles virus on cultured human thymic epithelial cells.

A tissue culture system for the growth of human fetal and infantile thymic epithelial (TE) cells has been established and characterized. We have investigated the effects of infection of these cells by human cytomegalovirus (CMV), measles virus, and human immunodeficiency virus type-1 (HIV-1). In the case of CMV, morphological changes were apparent by 2-4 days after viral inoculation of infantile TE cells. CMV-related antigens were detected by immunofluorescence after 12 days, and progeny infectious CMV was recovered from culture media after 18 days. Following infection by measles virus, distinctive, multinucleated giant TE cells appeared in both cultures of fetal and infantile TE cells. Measles virus-inoculated TE cells displayed an altered phenotype, as revealed by reaction with monoclonal antibodies with specificity for a variety of TE markers. Finally, infection of TE cells by HIV-1 resulted in cellular disarrangement, increased numbers of Hassall's corpuscles, and multinucleated giant cells. An increase in the number of cells reactive with monoclonal antibodies, specific for Hassall's corpuscles, was observed in the case of cells infected by either measles virus or HIV-1. These findings suggest that a variety of different viruses can successfully infect thymic epithelial tissue. Because of the important role of the thymus in development of the immune system, it is reasonable to conclude that viral infection of thymic tissue might play an important role in virus-mediated suppression of immune responsiveness.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Financing the medical management of mental disorders.

In 1987 Medicare benefits for the mentally ill were expanded for the first time in 22 years. A major change was the removal of limits and copayments for the "medical management of psychopharmacologic agents." Payment for medical management recognizes the trend toward the remedicalization of psychiatry; however, medical management can be defined either broadly or narrowly. The authors suggest pricing strategies for both medical management of mental disorders and psychotherapy. Enlightened design of psychiatric benefits will cover all forms of treatment according to appropriate rules. Access to treatment for mental illness is at stake as these rules develop.

Costs and Cost Analysis↗
PubMed1988

The decision to seek an exemption from PPS.

This paper examines the receipt of exemptions from Medicare's Prospective Payment System (PPS) for distinct part psychiatric units of general hospitals. A logit model of the exemption status of 1,045 psychiatric units is estimated using 1984 data. The results suggest that units that were expected to profit from a change in payment method (cost based on PPS) were least likely to obtain an exemption from PPS.

Data Collection↗
PubMed1988

Effect of co-incubation with cytomegalovirus on growth of interleukin 2-dependent lymphocytes.

We have tested the ability of human cytomegalovirus (CMV) to interfere with the interleukin-2 (IL-2)-dependent proliferation of T lymphocytes in long-term tissue culture. The results indicate that CMV was able to establish an apparently abortive infection in approximately 40% of such cells, although productive viral replication could not be detected, and was able to impede cellular proliferation almost completely. The addition of high concentrations of exogenous IL-2 to cultures of CMV co-incubated cells was not readily able to overcome the anti-proliferation inhibitory effect induced by this virus. Exposure to CMV led to an approximate 50% decrease in the number of cells which expressed Tac Ag, or IL-2 receptor, at the cell surface.

Cell Division↗
PubMed1988

Observer variation in the diagnosis of dysplasia in Barrett's esophagus.

The potential value of biopsy surveillance of patients with Barrett's esophagus for dysplasia is diminished by a lack of agreement on the diagnostic criteria for dysplasia. In a preliminary consensus conference, experienced gastrointestinal pathologists from four medical centers agreed on criteria for a five-tiered histologic classification of dysplasia in Barrett's esophagus--negative for dysplasia, indefinite for dysplasia, low-grade dysplasia, high-grade dysplasia, and intramucosal carcinoma. Eight morphologists in the four centers tested the criteria for interobserver agreement by examining a set of coded slides that had been chosen to include some especially difficult interpretative problems in all five histologic classifications. Interobserver agreement of 85 and 87% was achieved in successive reviews when the combined group of high-grade dysplasia and intramucosal carcinoma was compared with the combined group of low-grade dysplasia, indefinite for dysplasia, and negative for dysplasia. Comparison of other groups yielded less agreement. For example, negative for dysplasia could be distinguished from all other diagnoses with an interobserver agreement of 72%. We conclude that experienced gastrointestinal morphologists can diagnose high-grade dysplasia and intramucosal carcinoma with a high degree of agreement and thus can detect those patients who may need immediate rebiopsy or esophageal resection. Either further refinement of histologic criteria or alternate diagnostic methods will be needed to achieve the reproducible diagnosis of indefinite changes and low-grade dysplasia. This is important because patients with such changes theoretically merit closer endoscopic surveillance.

Barrett Esophagus↗
PubMed1988

Viral infection of human fetal islets of Langerhans. Replication of human cytomegalovirus in cultured human fetal pancreatic islets.

Tissue monolayer cultures of human fetal islets of Langerhans were infected with human cytomegalovirus (CMV). On the fourth day after inoculation, morphologic changes of monolayers were observed, including rounding up and floating of many cells. In addition, after this time CMV late antigen (LA) was detected in the inoculated cells. On the seventh day, CMV was recovered from the culture medium, and infected beta cells were identified by use of a double-label antibody technique. However, CMV apparently did not cause direct destruction of beta cells nor did infection by CMV lead to changes in production of insulin as measured by radioimmunoassay. Thus, despite the fact that CMV can successfully infect a variety of cells in fetal islets of Langerhans, the absence of a significant effect on beta cells does not support the notion that congenital CMV infection is involved in the origin of insulin-dependent diabetes mellitus.

Antigens, Viral↗
PubMed1988

Morphology, yield and functional integrity of islet-like cell clusters in tissue culture of human fetal pancreata obtained after different means of abortion.

Morphology, yield and function were studied in cultured islet-like cell clusters (ICC) from 140 human fetal pancreata obtained after abortions of different types performed at 11-23 weeks of gestation (12 by hysterotomy, 75 by mechanical dilation and extraction, and 53 induced with prostaglandin). After collagenase digestion and culture in medium supplemented with 10% human serum, up to 2000 free-floating ICC were formed from a single pancreas. Randomly scattered insulin- and glucagon-immunoreactive cells were found in the medullary part of the ICC. More than 100 ICC developed in 100% of the hysterotomies and 87% of the mechanical abortions, but in only 53% of the prostaglandin-induced abortions. Insulin and glucagon levels in the culture medium decreased rapidly during the first 7 days of culture, but then remained stable for at least 31 days. The hysterotomy-derived ICC responded to 10 mmol/l theophylline plus 20 mmol/l glucose by a 12.2 +/- 3.1 (SEM, N = 7) fold increase in insulin release, as compared with a 5.4 +/- 0.9 fold response of the prostaglandin ICC (N = 16; P less than 0.02). Despite the low proportion of B-cells, (pro)insulin biosynthesis accounted for 10% of the total protein biosynthesis in low (2 mmol/l) glucose. In conclusion, the yield and viability of the ICC were clearly better, if prostaglandin had not been used for the induction of the abortion.

Abortion, Induced↗
PubMed1988

Impact of SMBG on control of diabetes as measured by HbA1. 3-yr survey of a juvenile IDDM clinic.

Three hundred twelve diabetic children and adolescents were seen in our diabetic clinic and instructed to test their capillary blood glucose (CBG) twice daily and to use an algorithm to adjust their short-acting insulin. Of this group, 219 youngsters had a full 3-yr period of observation. At each clinic visit, blood was obtained for fasting blood glucose and HbA1 and, once a year, cholesterol and triglycerides were also measured. Patient and parent accuracy in measuring CBG was found to be adequate. The changes over time in HbA1 were nondifferential across age and sex, and there was no difference in the level of HbA1 between age and sex groups, the number of tests reported to have been done by the patients, the number of injections of insulin per day, or the serum cholesterol. There was a significant relationship between the HbA1 and the fasting blood glucose (P less than .001) measured by the laboratory as well as with the serum triglyceride (P less than .01). The failure to improve diabetic control, despite measures that would have been expected to do so, was believed to relate more to a lack of compliance than to a flaw in the therapeutic approach. It was interesting to note that the adolescent patients in the study were in no worse control than the younger children in the group. Although better technical skills are available today to manage diabetes, the psychosocial approach to patient motivation requires improvement.

Adolescent↗
PubMed1988

Infection of human thymic epithelial cells by human cytomegalovirus and other viruses: effect on secretion of interleukin 1-like activity.

Cultures of human thymic epithelial (TE) cells are able to produce a interleukin 1 (IL-1) like activity. This IL-1 activity can be detected either using mouse thymocytes in a traditional IL-1 assay, or using thymic lymphocytes obtained from cases of pediatric cardio-vascular surgery. Production of IL-1 activity by TE cells was found to be maximal between 3 and 4 weeks after culture initiation. Human thymocytes worked best as targets in an IL-1 assay, when these cells were derived from donors younger than 1 year of age. Infection of human TE cells by any of human cytomegalovirus, herpes simplex virus type 2, adenovirus 7, Coxsackie B1, and respiratory syncytial virus led to marked reductions in the ability of these cells to secrete measurable IL-1 activity. In the case of TE cells infected by cytomegalovirus, respiratory syncytial virus, and Coxsackie B1, this abrogation of production of IL-1 activity occurred in the absence of any obvious virus-induced cytopathic effect.

Cells, Cultured↗
PubMed1988

The early effects of Medicare's prospective payment system on psychiatry.

In this paper, we study the effects on psychiatry of Medicare's prospective payment system (PPS) during 1984, as PPS was implemented. We examined data on psychiatric discharges before and after PPS from three kinds of hospitals--those with psychiatric units exempt from PPS, those with nonexempt units, and those that treated psychiatric patients in scatter beds--as well as data on all hospital discharges. We conclude that the providers of psychiatric services responded to the incentives inherent in PPS much the way hospitals as a whole did--with significantly reduced lengths of stay. Of the three kinds of hospitals that rendered psychiatric care, those that treated patients in scatter beds had the greatest reduction in length of stay. Using readmission rates as a gross indicator of quality, we conclude that quality did not suffer because of the shortened stays.

Data Collection↗
PubMed1988

Pulmonary disease in infants and children.

Pulmonary diseases contribute significantly to the morbidity and mortality in children infected with the human immunodeficiency virus. The wide array of lung diseases spans from early acute bacterial infections, to the lymphoid interstitial pneumonitis/pulmonary lymphoid hyperplasia complex, to opportunistic infections. The unique clinical and histopathologic features of these diseases are reviewed.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Increased subepithelial collagen deposition is not specific for collagenous colitis.

To refine the pathologic diagnosis of collagenous colitis and to determine whether increased subepithelial collagen deposition (SCD) is specific for collagenous colitis (CC), we reviewed histologic sections of 1549 colonic mucosal biopsy procedures obtained from 1332 patients and 157 consecutive colonic resections. Quantitative evaluation of SCD was performed for those patients who showed thickness of SCD that was 5 microns or greater in either biopsies or resections, and the overall histologic and clinical features were correlated. A focal or diffuse increase of SCD greater than or equal to 5 microns was noted in 22 (1.7%) of the patients with biopsies and in 11 (7%) of the cases with resections. An otherwise unexplained, prolonged watery diarrhea was present in 6 (27%) of the 22 biopsy patients but in none of the patients with resections. These 6 patients with unexplained watery diarrhea had significantly greater amounts of SCD than those without this clinical feature both in terms of average thickness (21 microns versus 11 microns; P less than 0.02) and of the percentage of surface epithelium involved (47% versus 15%; P less than 0.02). Also, biopsies and resections with increased SCD from patients without watery diarrhea were all from the rectum and rectosigmoid region. These results lend further support to the nonspecificity of increased SCD and to the importance of the quantity of SCD, rather than its mere presence. In summary, increased SCD is not specific for CC; however, a greater amount of SCD is associated with a greater probability of associated watery diarrhea.(ABSTRACT TRUNCATED AT 250 WORDS)

Colitis↗
PubMed1987

Villous adenoma presenting as a vaginal polyp in a rectovaginal tract.

A 72-year-old woman had a villous adenoma of endodermal derivation involving the rectovaginal septum and contiguous mucosal surfaces that presented clinically as a vaginal polypoid tumor. To explain the vaginal involvement, we postulate that the adenoma traversed a tract of developmental origin within the rectovaginal septum. This is the first report of such a unique constellation of findings.

Adenoma↗
PubMed1987

A method for comparing two systems of acute 24-hour psychiatric care.

A quasi-experimental method was developed to evaluate the cost-effectiveness of a public system of 24-hour acute psychiatric care in Santa Clara County, California, before and after a new treatment setting was introduced. The original system relied on a 54-bed psychiatric unit in a county general hospital; the new system consisted of a 20-bed unit in the general hospital plus a 45-bed nonhospital psychiatric health facility. The study demonstrated that the per diem cost of the psychiatric health facility was approximately 60 percent that of the original general hospital unit, but the average difference in cost per episode between the two systems was only about +25, primarily due to longer lengths of stay in the new system. In addition, patients treated in the new, combined system appeared sicker at discharge than those treated in the old system. The findings suggest the importance of simultaneously evaluating both cost and treatment effectiveness to make sure that one element does not dominate program direction at the expense of the other.

Acute Disease↗
PubMed1987

Relationship between systolic and diastolic blood pressure and cognitive functioning in hypertensive subjects: an extension of previous findings.

The relationship between blood pressure and neuropsychological functioning in a group of 15 male hypertensives (mean age = 51.2 years) was studied. Thirteen of the 15 subjects showed cognitive deficits on a battery of neuropsychological tests. More significant negative correlations were found among test scores and systolic pressure than diastolic pressure. Stepwise multiple regression analyses confirmed significant relationships between both systolic and diastolic blood pressure and neuropsychological status. Following biofeedback training, subjects in whom blood pressure decreased the most showed the greatest improvement in Category Test performance. Findings suggest that level of systolic pressure is a sensitive predictor of hypertensives' intellectual and cognitive status, that it may be better than diastolic level, and that decreasing blood pressure is predictive of reversal of at least some of the cognitive impairments associated with hypertension.

Journal Article↗
PubMed1987

ACTH-related peptides, kindling and seizure disorders.

Very small amounts of pituitary hormones and their peptide fragments can profoundly affect learning, memory and other behaviors in both rodents and humans. In addition, several potent pituitary hormone analogs have been developed (e.g. ORG-2766) which retain the behavioral but not the endocrine properties of the parent hormone. The abilities of these peptides to influence nervous system functions suggested that they also may be capable of modifying seizure activity. This possibility is supported by the fact that treatment with adrenocorticotropic hormone (ACTH) represents a major effective therapy for at least one clinical convulsive disorder, infantile spasm. This contention also is reinforced by our findings that ORG-2766 markedly reduces both the behavioral severity and the spread of seizure potentials in an animal model of epilepsy, the kindled rat. By contrast, arginine vasopressin and its non-endocrine desglycyl fragment (DGAVP) facilitates the seizure process in this animal model. Our research also suggests that the behavioral and physiological effects of certain anterior and posterior pituitary hormone fragments depend, in part, on their abilities to modulate permeability mechanisms in brain vasculature. In addition, and especially significant from the standpoint of etiology, is the observation that the kindling process itself appears to alter cerebrovascular permeability. In the kindled rat, "permanent" decreases in permeability (60-75%) are found selectively in the hypothalamic and hippocampal regions, weeks after the last seizure. Several lines of evidence indicate that disruption of normal cerebrovascular function occurs following epileptiform seizures. We propose that an immediate increase in cerebral blood flow and cerebrovascular permeability occurs following a single, acute seizure, and that repeated chronic seizures lead to damage to the cerebrovascular system. Sustained damage would be expected to contribute to the development and maintenance of a chronic seizure focus. Such observations suggest a link between important cerebrovascular disturbances associated with seizures and the existing known and proposed electrophysiological, metabolic and neuropathological substrates of epilepsy. They also point to new strategies for the treatment of seizure disorders by focusing on ways to reduce or prevent cerebrovascular damage.

Adrenocorticotropic Hormone↗