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Biomedical subjects

J D Goldstein

Publications and source records attributed to J D Goldstein.

At least 37 records · Page 2Linked to original sources
PubMed1982

Pathologic patterns of Serratia marcescens pneumonia.

To characterize the pulmonary lesions caused by Serratia marcescens, the authors reviewed all autopsy-culture-proven cases of S. marcescens pneumonia occurring at their hospital between 1968 and mid-1980. In 16, S. marcescens was the only organism cultured from the lungs during life or at autopsy. This report describes primarily these pure infections. Two histopathologic reactions were seen. Nine non-neutropenic patients had acute, hemorrhagic bronchopneumonia, seven with microabscesses and two with larger cavities. In seven, distinctive vasculitis was apparent in vessels larger than 75 microns in diameter; intramural gram-negative rods were identified in two. Seven immunosuppressed patients had diffuse neutropenic pneumonitis resembling diffuse alveolar damage, with extensive intra-alveolar fibrinous exudates and pulmonary hemorrhage. In two patients, bacteria without cellular reaction were present. In patients with prolonged infections, focal areas of intra-alveolar organization and bronchiolitis obliterans accompanied both patterns. Since the incidence of nosocomial S. marcescens infection is increasing and since pneumonia caused by this organism is recognizable histologically, autopsy cultures positive for S. marcescens should not be disregarded.

Adult↗
PubMed1982

Sporadic Legionellaceae pneumonia in renal transplant recipients. A survey of 70 autopsies, 1964 to 1979.

The discovery in recent years of previously unrecognized pathogenic bacteria now classified in the family Legionellaceae raised the possibility that significant but undetected infections from these organisms might have occurred in the past. The known susceptibility of immunosuppressed patients to these organisms led us to examine, by direct immunofluorescence, lung tissue from 70 autopsies of renal transplant recipients. Only two cases were detected, one each due to Legionella bozemanii (WIGA) and L micdadei (Pittsburgh pneumonia gent). The lack of cases in this high-risk population contrasts with recent outbreaks at several other institutions and highlights the focal and frequently nosocomial distribution of these infections. A reservoir for these organisms probably did not exist at the Peter Bent Brigham Hospital, Boston, during the 15-years period of this study.

Adult↗
PubMed1981

The structural basis of persistent pulmonary hypertension of the newborn infant.

Six neonates of 35 to 42 weeks' gestation had findings of persistent pulmonary hypertension and died between one and 6 days of age despite intensive medical therapy. Each patient had pulmonary artery pressure near or above systemic level, with a right-to-left shunt via the foramen ovale and/or ductus arteriosus. At postmortem, morphometric analysis of the peripheral pulmonary vascular bed revealed extension of muscle into small arteries, which was severe in five of six patients; all alveolar duct and wall arteries (less than 30 micrometers external diameter), normally nonmuscular, were fully muscularized. In these five patients medial wall thickness of the normally muscular intra-acinar arteries was doubled; arterial size and number, however, were normal in all. This striking structural maldevelopment of the peripheral pulmonary arterial bed occurred or was initiated in utero and does not merely represent a failure of the fetal pattern to regress. We suggest that this particular group of patients remained refractory to all current modes of therapy because of these severe structural pulmonary vascular changes.

Humans↗
PubMed1981

Effect of sodium nitroprusside on hypoxic pulmonary vasoconstriction in the dog.

The objective of the study was to determine the direct actions of sodium nitroprusside (SNP) on the pulmonary vasculature actively constricted by hypoxic ventilation in the closed-chest dog. In 21 supine anesthetized (pentobarbital sodium, 25 mg/kg) dogs the left lower lobe was catheterized with a 20 F wedged-flow catheter. With constant flow to this lung lobe, lobar pulmonary artery pressure (PAP), left ventricular end-diastolic pressure (LVEDP), and lobar pulmonary vascular resistance (PVR) were studied during room air and 10% O2 mechanical ventilation. With lobar flow and LVEDP constant, observed changes of lobar PAP and PVR represent direct effects on vascular tone unaffected by passive factors. Ventilation with 10% O2 resulted in a significant increase in lobar PAP [12.2 +/- 1.6 to 17.2 +/- 1.2 (SE) Torr] and PVR [42.2 +/- 13.3 to 61.2 +/- 15.0 (SE) Torr X 1(-1) X min]. Then during continued hypoxia in 12 animals, femoral vein infusion of SNP at doses of 1, 2, and 5 microgram X kg-1 X min-1 resulted in significant decreases in lobar PAP to 14.8 +/- 1.5, 14.8 +/- 1.5, and 13.4 +/- 1.6 Torr, respectively, and in PVR to 56.7 +/- 14.1, 54.0 +/- 13.9, and 47.8 %/- 13.2 Torr X 1(-1) X min, respectively. In six animals the sequence of drug infusion was then reversed with similar results. It is concluded that the actively constricted pulmonary vascular bed is directly dilated by SNP infusion.

Animals↗
PubMed1980

Pulmonary hypoplasia resulting from phrenic nerve agenesis and diaphragmatic amyoplasia.

We report the clinical, general postmortem, and pulmonary morphometric features of a unique case of pulmonary hypoplasia resulting from phrenic nerve agenesis and diaphragmatic amyoplasia. The lungs showed a marked reduction in the number of bronchial branches with relatively normal intra-acinar growth, indicating interference with lung development before the sixteenth week of gestation. The pulmonary abnormalities arose early in gestation, suggesting that normal diaphragmatic neuromuscular development is essential for maintaining thoracic volume and permitting lung growth even before the fetus is capable of regular respiratory movements. The infant also had remodeling of the pulmonary circulation, causing persistent pulmonary hypertension. This case clarifies the interrelationship of diaphragmatic innervation, thoracic volume, fetal respiration, and lung development.

Abnormalities, Multiple↗
PubMed1979

Unusual vascular anomalies causing persistent pulmonary hypertension in a newborn.

A unique case of pulmonary vascular anomalies causing persistent pulmonary hypertension in a newborn is described. The child died 3 days after birth. Necropsy revealed marked hypoplasia of the right and left pulmonary arteries with a normal main pulmonary artery, patent ductus arteriosus, bilateral systemic arteries to the lungs from the abdominal aorta, and partial anomalous pulmonary venous connection. Quantitative morphometric techniques demonstrated slight abnormalities of alveolar development and severe arterial medial hypertrophy with abnormal extension of muscle into small peripheral arteries. Bronchopulmonary development appeared relatively normal in spite of the vascular abnormalities.

Angiocardiography↗
PubMedDate not supplied

Maternally inherited mitochondrial cardiomyopathy associated with a C-to-T transition at nucleotide 3303 of mitochondrial DNA in the tRNA(Leu(UUR)) gene.

Disorders associated with mitochondrial DNA (mtDNA) mutations are usually dominated by involvement of the nervous system and skeletal muscle (hence the term "mitochondrial encephalomyopathies"). However, considering the high dependence of the heart on oxidative metabolism, it is not surprising that myocardial dysfunction is often a prominent feature in these disorders, either as isolated cardiomyopathy or as part of a multisystem mitochondrial syndrome. We report an infant with a maternally inherited C-to-T transition at nucleotide 3303 of mtDNA in the tRNA(Leu(UUR)) gene; this is the second kindred with cardiomyopathy identified to have this mutation of mitochondrial DNA. A brief review of other mitochondrial DNA defects is also included.

Cardiomyopathy, Hypertrophic↗
PubMedDate not supplied

CT appearance of primary CNS lymphoma in patients with acquired immunodeficiency syndrome.

Cranial CT studies of 32 patients with biopsy-proven AIDS-related primary CNS lymphoma were reviewed retrospectively. A wide variety of different CT appearances were identified. Mass lesions varied in location, size, and number. Most lesions were either iso- or hyperdense and all enhanced with contrast medium. Several different patterns of enhancement were observed. Mass effect and edema were seen in almost all patients. After radiotherapy, most tumors decreased in diameter, became hypodense, and no longer enhanced with contrast medium. Edema and mass effect decreased or resolved in all but one patient. Postradiotherapy CT scans also revealed interval enlargement of the ventricles and cortical sulci. This study demonstrates the wide diversity of CT appearances of AIDS-related primary CNS lymphoma. The CT findings cannot be used in lieu of biopsy for diagnosis of this disorder. The appearance of postradiotherapy CT scans was consistent with regressing lymphoma.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Spine injuries in gymnasts and swimmers. An epidemiologic investigation.

Three groups of top level female gymnasts of preelite, elite, national and Olympic caliber were studied without regard to back pain or injury. These athletes were compared to a similar group of national caliber female swimmers. Magnetic resonance imaging scans of each participant were used to document disk or bony abnormalities. The relationship between magnetic resonance imaging findings and age, height, weight, previous injuries, back symptoms, and hours of training per week each year was examined. Nine percent of preelite (1/11), 43% of elite (6/14), and 63% of Olympic level (5/8) gymnasts had spine abnormalities; 15.8% of all swimmers had spine abnormalities. Average hours of training per week and age were found to be associated with abnormalities seen on magnetic resonance imaging. Increased intensity and length of training correlated with previous data that suggests the female gymnast is prone to spine injuries.

Adolescent↗
PubMedDate not supplied

A comparison of patellar tendon autograft and allograft used for anterior cruciate ligament reconstruction in the goat model.

Similar-sized patellar tendon autografts and fresh-frozen allografts were used to reconstruct the anterior cruciate ligament of one knee in 40 female goats. Evaluations of the reconstructions and contralateral controls at the 6-week and 6-month postoperative periods included anterior-posterior translation, mechanical properties determined during tensile failure tests, measurement of cross-sectional area, histology, collagen fibril size and area distribution, and associated articular cartilage degenerative changes. Six months after anterior cruciate ligament reconstruction, the autografts demonstrated a smaller increase in anterior-posterior displacement, values of maximum force to failure two times greater, a significant increase in cross-sectional area, a more rapid loss of large-diameter collagen fibrils, and an increased density and number of small-diameter collagen fibrils compared to the allografts. Clinical significance. More surgeons are allowing their patients to return to running and sports 6 months after anterior cruciate ligament reconstruction. While the structural and material properties of autografts and allografts at time zero are similar, in the goat model during the first 6 months they differ. The allografts demonstrate a greater decrease in their implantation structural properties, a slower rate of biologic incorporation, and the prolonged presence of an inflammatory response. At 6 months the autograft demonstrates a more robust biologic response, improved stability, and increased strength to failure values.

Animals↗