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Biomedical subjects

H S Goldstein

Publications and source records attributed to H S Goldstein.

At least 19 recordsLinked to original sources

A plethysmographic method for demonstrating the response specificity of the oral vascular bed.

In this paper, we describe a new method for measuring the oral plethysmogram, and we assess its sensitivity and specificity under differing psychological stimulation. Finger and palate pulse amplitudes and blood pressure were monitored while individuals (N = 13) performed several tasks: mental arithmetic, nausea imagery, fear imagery, and anger imagery. Pulse pressure, having a major effect on pulse amplitude, was partialed out in analyses. Palate pulse amplitude increased significantly in response to the degree to which the individual felt irritated, judged, nauseated, or angry. In contrast, finger pulse amplitude changed significantly only in the arithmetic task and, unlike the palate, showed a decreased amplitude with increased irritation and being judged. Results indicate that the oral plethysmogram can serve as a reliable measure of oral mucosal vasomotor reactivity and that it has a different pattern of response specificity than does the finger.

Adult↗

Uric acid level increases in humans engaged in gambling: a preliminary report.

The effect of gambling and gaming on plasma levels of uric acid was studied. Blood samples were obtained from normal subjects while they gambled for money or while they played checkers without betting. There was an interaction of time and activity reflecting primarily an association of increased uric acid levels during gambling over time, compared with gaming and relaxation. This indicates that gambling can increase plasma levels of uric acid.

Adult↗

Placement of drains in laparoscopic procedures.

The technique of laparoscopic cholecystectomy is, in many areas, replacing the standard open cholecystectomy as the method of choice. Many surgeons are accustomed to the use of peritoneal drainage following cholecystectomy. The authors have developed a simple, effective, and rapid, yet controlled method of placing drains into the abdominal cavity, using laparoscopic techniques.

Cholecystectomy↗

Slit mesh for hernia repair.

A precise method of placing synthetic material during inguinal hernia repair is described. The material is slit at the inferior position to the internal ring so that its continuity is least compromised.

Hernia, Inguinal↗

Laparoscopic cholecystectomy in acute cholecystitis.

The experience of laparoscopic cholecystectomy in 79 patients with acute cholecystitis is described. This group is subdivided into acute and severe acute cholecystitis. These categories are defined. Six percent of our patients with acute disease and 30% of our patients with severe acute disease were converted to open cholecystectomy. Those patients who were converted to open cholecystectomy are discussed. The four port technique and decompression of the gallbladder is described. We conclude that acute cholecystitis should not be a contra-indication to the well-trained laparoscopic surgeon.

Acute Disease↗

Laparoscopic choledocholithotomy.

Common duct stones present a special problem to the surgeon when he performs a laparoscopic cholecystectomy. We describe a method of exploring the common duct and extracting stones. The procedures for opening of the common duct, removal of stones, and the placement of a T-tube are carefully outlined.

Catheterization↗

Suppressor effects in the relations of psychological variables to resting blood pressure.

The role of suppressor effects in obscuring the relation of psychological variables and blood pressure was studied. Forty-five nonmedicated patients in a family practice rated themselves relative to their peers on a series of characteristics. Two of these, trapped and lonely, exhibited marked suppressor effects in their relationship with each other and resting blood pressure. Self-ratings of lonely exhibited a moderately strong positive association with ratings of trapped (r = .63) while only ratings of lonely showed a significant correlation with resting systolic blood pressure (r = .31). Yet when the suppressor effects of the ratings on feeling lonely were removed in the regression analyses, the ratings on feeling trapped showed a significant positive association with resting systolic pressure (r = .42). Similarly, while neither ratings on feeling lonely or on feeling trapped showed separately a significant association with resting diastolic pressure, when suppressor effects were removed in the regression analyses, the ratings of trapped were significantly associated with diastolic pressure in a positive direction (r = .34) and ratings of lonely were significantly associated in a negative direction (r = .33). The significance of this specific suppressor effect and the implications of suppression for psychosomatic research are discussed.

Adult↗

Minimally invasive colon resection (laparoscopic colectomy).

The successful application of laparoscopic surgery to gallbladder disease and acute appendicitis has encouraged clinical investigators to develop this technology further in an attempt to manage other pathologic disorders of the gastrointestinal (GI) tract. After gaining experience with various laparoscopic skills while performing clinical biliary tract surgery, appendectomy and then in a controlled animal laboratory, a pilot program for laparoscopic colonic surgery was initiated. Twenty patients with ages ranging from 43 to 88 years (mean age of 57 years) underwent laparoscope-assisted colon resection. In nine patients, a right hemicolectomy was performed and a sigmoid colectomy in eight. A low anterior resection, Hartman's procedure, and abdominal perineal resection were each performed in one patient. Indications for surgery were large villous adenomas or adenocarcinoma in 12, diverticular disease in 5, sigmoid endometrioma in 1, cecal volvulus in 1, and inflammatory bowel disease in 1. Eighty percent of patients were able to tolerate a liquid diet on the first postoperative day and 70% were discharged within 96 h eating a regular diet and having normal bowel movements. There were three operative complications: a 3 unit postoperative bleed managed without surgery, one patient developed marked edema of the rectosigmoid anastomosis requiring decompression with a rectal tube, and one individual with metastatic colon cancer was operated on for a mechanical small bowel obstruction 7 days after the initial laparoscopic surgery. Although laparoscope-assisted colonic surgery may still be considered a procedure in evolution, we feel that in time it has the potential to be as popular as laparoscopic cholecystectomy.

Adult↗

Parkinson's disease, personality, and dopamine.

Clinicians have long observed an anecdotal association of Parkinson's disease with stoic, industrious, and inflexible personality traits, both premorbidly and after the onset of motor symptoms. In this study, using the Tridimensional Personality Questionnaire, we found significantly less novelty-seeking behavior (behavior thought to be dopamine-dependent) in Parkinson's disease patients than in matched controls, but no differences between groups in behaviors thought to be dependent on serotonin and norepinephrine. We discuss the literature and propose a mechanism that may explain the relationship between brain dopaminergic systems and personality in Parkinson's disease.

Arousal↗

Relationship of expressed anger to forearm muscle vascular resistance.

The relationship of style of anger expression to physiological reactivity was examined in 45 nonmedicated subjects during their performance of three tasks with contrasting response demands. The primary physiological focus was on forearm muscle vascular resistance (FMVR) with forearm muscle blood flow (FMBF), digital pulse volume (DPV), digital vascular resistance (DVR), heart rate (HR), diastolic blood pressure (DBP), systolic blood pressure (SBP), and electrodermal frequency (EF) monitored. Family Expressed Anger, i.e. the overtness of anger expression in the subject's family of origin, was related to FMVR such that the more anger was expressed in the family of origin, the greater the vasoconstriction during Mental Arithmetic and the less the vasoconstriction during Anger Imagery. Self Expressed Anger, i.e. the degree to which others were aware when the subject was feeling angry, was related to SBP and DBP during Vigilance with a lesser degree of anger expression going with greater blood pressure increases. The meaning of these findings in relation to task appraisal and task demand is discussed.

Adult↗

Skeletal maturity and cognitive development of 12- to 17-year-old males.

The relationship between skeletal age and cognitive ability was examined in a probability sample representative of 12- to 17-year-old males in the United States. Skeletal age was measured by radiographic determination of bone maturation. Cognitive development was assessed by WISC Vocabulary and Block-design subtests. The analyses demonstrated a significant positive relationship between skeletal age and cognitive development, with chronological age controlled.

Adolescent↗

The paradoxical relation between diastolic blood pressure change under stress and the H factor of the Jenkins Activity Survey.

This study examined the relation of the Type A scale and of the three factors of the Jenkins Activity Survey to the cardiovascular responses of twenty-six subjects during two stressful tasks. The two tasks were reaction time (RT) and paced arithmetic (PA) and the sample was drawn from a general medical practice. While heart rate correlated directly with the subject's score on the Hard Driving and Competitive Factor (H), diastolic blood pressure response to PA was inversely related to the subject's Type A and factor H scores. This paradoxical inverse relation remained highly significant when the diastolic pressure in the rest preceding PA was statistically controlled.

Adult↗

Family emotional health: a survey of family practice patients.

As a step toward defining psychosocial areas in which resident training in family medicine is needed, this study assessed the concerns patients had about the emotional health of their families. A questionnaire was developed to survey the patient concerns (ie, worries or perceived problems) for the developmental, psychological, and social functioning of their families. Patients in three family practice settings were administered the questionnaire while waiting for their appointments. Sixty-four percent of the patients perceived one or more areas of concern in their families. Close to half (48.9 percent) had concerns about themselves. Concerns about the emotional well-being of spouses were identified by 39.5 percent of those having spouses, and for children, 38.2 percent of those having children. Also, 39.7 percent expressed concern about their parents' emotional health. Further, while only 3.5 percent of the patients were given a psychiatric diagnosis, 26.5 percent of the charts contained notes revealing psychosocial problems at some patient visit. The results point to a major need for family physicians to develop skills in child, adult, and family evaluation of psychosocial functioning.

Adult↗

Self-evaluation by residents in family medicine.

Accurate self-evaluation is central to a family physician's professional growth both during and after the residency training period. Self-evaluations of residents' interviewing skills, as demonstrated in videotaped interviews with simulated patients, were compared to multiple faculty evaluations as part of an annual assessment. Means for resident evaluations were lower and showed greater variations than faculty ratings but correlated significantly in several areas. Inter-rater reliability coefficients were highest when criteria were most specific. Residents benefited from the opportunity to compare and discuss their perceptions with those of objective and competent raters.

Educational Measurement↗