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Biomedical subjects

J Gold

Publications and source records attributed to J Gold.

At least 55 records · Page 3Linked to original sources
PubMed1998

A novel multi-segment surface coil for neuro-functional magnetic resonance imaging.

The construction of two novel mult-segment (MS) resonators are described. The signal-to-noise ratio (SNR) and B1 homogeneity of the coils are compared with that of a surface coil and a standard quadrature head coil. The images obtained with the MS designs revealed a surface coil-like fall-off in signal with depth. The SNR offered by MS coils was found to be better than the head coil at depths less than approximately 6 cm. Bilateral motor cortex activation on normal subjects performing finger tapping tasks is demonstrated.

Equipment Design↗
PubMed1998

High-dose (2000-microgram) intravitreous ganciclovir in the treatment of cytomegalovirus retinitis.

OBJECTIVE: The authors prospectively studied visual outcome, relapse, complications, and survival of patients with acquired immune deficiency syndrome (AIDS)-related cytomegalovirus (CMV) treated with high-dose intravitreous ganciclovir (2 mg/0.1 ml) injections. The outcomes were compared with those of patients treated with standard doses of intravenous ganciclovir in the same institution. The histopathologic and electrophysiologic effects of high-dose intravitreous ganciclovir injections in rabbits also were studied. DESIGN: A nonrandomized case series. PARTICIPANTS: A total of 42 patients (74 eyes) were treated with intravitreous injections and 18 patients (27 eyes) were treated with intravenous ganciclovir. Five eyes of three New Zealand white rabbits were injected with ganciclovir, and the sixth eye was a control specimen. INTERVENTION: Patients treated with intravitreous injections received twice-weekly doses of 2 mg/0.1 ml ganciclovir for 3 weeks, then weekly injections. Patients treated with intravenous ganciclovir received standard doses. Patients were monitored with regular examinations. Rabbit eyes were given intravitreous injections of 1 mg/0.1 ml of ganciclovir weekly for 4 weeks. MAIN OUTCOME MEASURES: Assessments of vision, retinal inflammation, and survival were made. Electroretinograms were performed on the rabbit eyes, and they were processed for light and electron microscopy. RESULTS: In the intravitreous group, visual acuity (VA) was stable in 64 of 74 eyes, 5 improved, and 5 deteriorated. Sixty-three (85%) of 74 eyes had final VA of 20/20 to 20/40. Relapse occurred in five eyes (7%; median time, 42 weeks). There were three cases of endophthalmitis. Median survival after diagnosis of CMV retinitis was 36 weeks. In the intravenous group, VA was stable in 18 eyes, 0 improved, and 9 deteriorated. Sixteen (59%) of 27 eyes had final VA of 20/20 to 20/40. Relapse occurred in 15 eyes (56%) at a median time of 21 weeks. Median survival was 21 weeks. The rabbit studies showed no evidence of toxicity. CONCLUSION: High-dose intravitreous ganciclovir effectively suppressed CMV retinitis, preserved vision, and prevented relapse without deterioration in survival.

AIDS-Related Opportunistic Infections↗
PubMed1998

The Albion Street Centre database, Sydney, Australia.

The Albion Street Centre was established in 1985 as an HIV testing and early management center. More than 22,000 people have been screened for HIV and other blood-borne infections at the Centre, and approximately 3,600 people with HIV/AIDS have been managed there. Approximately 1,600 patients with various stages of HIV disease are currently managed at the Centre by a staff of 60 health care professionals and about 1,000 volunteers. The Albion Street Centre's computer database began recording selected demographic, epidemiologic, clinical, and laboratory characteristics when the first patient presented in 1985. Since then, the complexity and utilization of the database has increased in parallel with improvement in the understanding of the natural history and pathogenesis of HIV infection. Over 100 peer-reviewed publications and presentations have been produced from the database and 45 clinical trials have used the database to identify potential subjects. All data are de-identified and are protected by multiple password codes. Approximately 700 variables are collected from each HIV-positive patient at the initial visit to the Centre and up to 200 variables are added at each subsequent routine clinic visit. The variables collected include the following: standard epidemiologic characteristics; transmission and behavioral parameters, clinical signs and symptoms; laboratory test results; treatments; nutritional history; body composition parameters; psychological assessment results; and management history, including neuropsychological testing. The overall number and characteristics of patients recorded in the database are reported monthly, and are used to plan services, for prevention and educational programs, and as an indicator of the effectiveness of campaigns to encourage HIV-positive people to attend clinics for early management. When these patients have been identified they are invited to participate in the study. Individual patient records are identified and accessed if they meet certain criteria for flagging. For example, patients who have lost more than 5% of their maximal weight are flagged and referred to the dietician for assessment. Further uses for the database are to identify cohorts of patients who are seroconverters and to follow their natural history-the Centre has over 250 patients for whom a documented HIV-positive test has been obtained within 12 months of a documented HIV-negative test; to investigate clinical observations that have been associated with particular drug therapy, e.g., investigation of the reported association between the use of valacyclovir and the thrombotic thrombocytopenic purpura/hemolytic uremic syndrome (TTP/HUS)-like complex showed patients with terminal-stage AIDS demonstrated this syndrome independently of their therapy and probably as a consequence of multiorgan failure; and to document the relationship between nutritional intervention and survival, for which use of the database enabled an historical cohort that matched the cases under investigation to be selected. In conclusion, the database is a dynamic and integral part of the assessment, management, and research program of the Albion Street Centre, where it is used by all professional staff.

Adolescent↗
PubMed1997

Morphological and chemical characterization of microfabricated fibres for biological applications.

Monodisperse fibres and particulates of different materials with controllable three-dimensional shape, size and chemical composition are of interest in research on toxic respirable fibres as well as wear debris around orthopaedic implants. We have previously demonstrated the production of well-controlled, metal and oxide microfabricated fibres having dimensions 0.1 to 10 microm. While our previous results focused on how controlled fibres can be prepared by microfabrication methods, this paper evaluates property-production relationships for microfabricated fibres. Here we have briefly reviewed the production of 0.1 microm x 0.5 microm x 10 microm microfabricated fibres made by electron beam lithography from evaporated titanium or silicon oxide films using a double lift-off method. We have also analysed the properties of these fibres with respect to morphology and chemical composition, and how they are affected by variations in the production process. Two different solution types have been used to place fibres into liquid suspension and to clean and sterilize them for biological testing. One method involves the use of organic solvents; the other a hydroxide solution and water. While fibre dimensions appear to be material-specific, differences can be corrected for by compensation of the size of the lithographic pattern. Similarly the crystallinity of fibres is material-specific, as is to be expected of evaporated thin films, but should be possible to modify by varying deposition parameters or heat treating, for example. Of the cleaning methods used, the one using an aqueous hydroxide solution is preferred over solvent cleaning, as it is easier to perform and appears to be more effective at removing resist from the fibre suspension.

Journal Article↗
PubMed1997

Rate of seasonal spread of respiratory syncytial virus in a pediatric hospital.

The rate of nosocomial respiratory syncytial virus (RSV) infection was measured in a large pediatric hospital using an incidence density method. The at-risk days for nosocomial RSV were summed during a defined winter period in which there were 54 admissions with community-acquired RSV infection giving a rate of 2.9 cases per 1,000 at-risk days (95% confidence interval, 0.3-5.4 per 1,000).

Community-Acquired Infections↗
PubMed1997

Effect of the intensity of transcutaneous acupoint electrical stimulation on the postoperative analgesic requirement.

Given the inherent side effects associated with both opioid and nonopioid analgesic drugs, a nonpharmacologic therapy that could decrease the need for analgesic medication would be valuable. We designed a sham-controlled study to assess the effect of the intensity of transcutaneous acupoint electrical stimulation (TAES) on postoperative patient-controlled analgesia (PCA) requirement for hydromorphone (HM), the incidence of opioid-related side effects, and the recovery profile after lower abdominal surgery. One hundred one healthy consenting women undergoing lower abdominal procedures with a standardized general anesthetic technique were randomly assigned to one of four postoperative analgesic treatment regimens: Group I (n = 26) PCA only; Group II (n = 25), PCA + sham-TAES (no electrical stimulation); Group III (n = 25), PCA + low-TAES (4-5 mA of electrical stimulation); Group IV (n = 25), PCA + high-TAES (9-12 mA of electrical stimulation). The PCA device was programmed to deliver HM, 0.2-0.4 mg intravenously boluses "on demand," with a minimum lockout interval of 10 min. The TAES skin electrodes were placed at the Hegu acupoint on the nondominant hand and on both sides of the surgical incision. The TAES frequency was set in the dense-and-disperse mode, alternating at 2 Hz and 100 Hz every 3 s, with stimulation of the hand and incision alternated every 6 s. The patients in Groups II-IV were instructed to use TAES every 2 h for 30 min while awake. After discontinuation of PCA, oral pain medications were administered on demand. The postoperative PCA-HM requirement, pain scores, opioid-related side effects, and requirements for antiemetic and antipruritic medication were recorded. High-TAES decreased the HM requirement by 65% and reduced the duration of PCA therapy, as well as the incidence of nausea, dizziness, and pruritus. Low-TAES produced a 34% decrease in the HM requirement compared with only 23% in the "sham" TAES group. We conclude that high-TAES produced a significant decrease in the PCA opioid requirement and opioid-related side effects after low intraabdominal surgery.

Abdomen↗
PubMed1997

Chemical characterization and reactivity of iron chelator-treated amphibole asbestos.

Iron in amphibole asbestos is implicated in the pathogenicity of inhaled fibers. Evidence includes the observation that iron chelators can suppress fiber-induced tissue damage. This is believed to occur via the diminished production of fiber-associated reactive oxygen species. The purpose of this study was to explore possible mechanisms for the reduction of fiber toxicity by iron chelator treatments. We studied changes in the amount and the oxidation states of bulk and surface iron in crocidolite and amosite asbestos that were treated with iron-chelating desferrioxamine, ferrozine, sodium ascorbate, and phosphate buffer solutions. The results have been compared with the ability of the fibers to produce free radicals and decompose hydrogen peroxide in a cell-free system in vitro. We found that chelators can affect the amount of iron at the surface of the asbestos fibers and its valence, and that they can modify the chemical reactivity of these surfaces. However, we found no obvious or direct correlations between fiber reactivity and the amount of iron removed, the amount of iron at the fiber surface, or the oxidation state of surface iron. Our results suggest that surface Fe3+ ions may play a role in fiber-related carboxylate radical formation, and that desferrioxamine and phosphate groups detected at treated fiber surfaces may play a role in diminishing and enhancing, respectively, fiber redox activity. It is proposed that iron mobility in the silicate structure may play a larger role in the chemical reactivity of asbestos than previously assumed.

Asbestos, Amphibole↗
PubMed1997

Pain and pain management in newborn infants: a survey of physicians and nurses.

BACKGROUND: Despite an increased awareness among clinicians regarding pain and pain management for infants undergoing surgery, pain associated with procedures performed outside the operating room may not be adequately managed. PURPOSE: To examine the beliefs and self-described behavior of physicians and nurses regarding the management of procedural pain in newborn infants. METHODS: A survey was distributed to 467 clinicians (nurses and physicians) working in 11 level II and 4 level III nurseries in a large metropolitan area. Respondents were asked to rate the painfulness of 12 common bedside nursery procedures and how often pharmacologic and nonpharmacologic (comfort) measures are currently used and should be used for those procedures. Demographic data were also collected. RESULTS: Surveys were completed by 374 clinicians (80% response rate). Physicians and nurses believe infants feel as much pain as adults and that 9 of the 12 listed procedures are moderately to very painful. Neither pharmacologic nor comfort measures are believed to be used frequently, even for the most painful procedures. Physicians and nurses believe both pharmacologic and comfort measures should be used more frequently, but nurses believe comfort measures should be used more frequently than do physicians. Beliefs about infant pain and procedural pain were related to pain management preferences. Physicians' but not nurses' ratings were associated with significant personal pain. CONCLUSIONS: Despite their beliefs that infants experience significant procedure-related pain, clinicians believe pain management for infants remains below optimal levels. Barriers to more consistent and effective pain management need to be identified and surmounted.

Attitude of Health Personnel↗
PubMed1997

Cerebral complications in cardiac surgery: changing concepts and technologic advances.

Coronary artery bypass surgery is an effective treatment for patients with multivessel coronary artery disease. The overall mortality and cardiac morbidity associated with the procedure has progressively declined since the early days, mostly attributable to improvements in surgical and anesthetic techniques. Over the same period, however, the average age of patients undergoing surgery has risen considerably, and with it, the incidence of neurologic complications. Currently, neurologic complications are the leading cause of morbidity associated with the procedure, and death due to neurologic causes has increased from 7% to 20% of all deaths. These complications are reflected in prolonged hospitalization of patients, at dramatic cost both to the patient and to the health system as a whole.

Journal Article↗
PubMed1996

Dobutamine stress testing in the cardiac catheterization laboratory.

Dobutamine stress ventriculography is a safe test that appears to separate groups of patients with and without significant coronary artery stenoses. In this study, all 7 patients with significant coronary artery stenoses who reached a heart rate > or = 110 beats/min had a positive stress test, whereas 9 of 10 control patients had a negative stress test.

Adult↗
PubMed1996

Safety and efficacy of nandrolone decanoate for treatment of wasting in patients with HIV infection.

OBJECTIVE: To evaluate the safety and efficacy of the anabolic steroid, nandrolone decanoate (Deca Durabolin) in patients with HIV wasting who are resistant to nutritional intervention. DESIGN: A 16-week open trial with subjects who had lost 5-15% of their usual body weight. SETTING: HIV/AIDS specialist ambulatory care services, both public and private, in sydney, Australia. PARTICIPANTS: Two hundred and twenty men entered the pre-therapy phase, and of these, 24 failed to gain weight and were enrolled. Seventeen subjects (81%) completed the 16-week trial. INTERVENTIONS: Pre-therapy nutritional assessment and education was conducted by the clinical dietitian. Those who failed to gain weight (10.9%) were treated with nandrolone decanoate (100 mg/ml) by deep intramuscular injection every 2 weeks for 16 weeks. MAIN OUTCOME MEASURES: Changes in weight and body composition (lean body mass, total body water and nitrogen index) were measured by anthropometry, bioelectrical impedance, and in vivo neutron activation. Changes in quality of life were assessed by the 30-item Medical Outcomes Study short form questionnaire. Changes in biochemistry, haematology and immunology were also measured. RESULTS: There were significant increases in weight (mean, 0.14 kg per week; P < 0.05) and lean body mass (mean, 3 kg by anthropometry; P < 0.005). The change in lean body mass was of similar magnitude across all measurement modalities. Quality of life parameters, especially functionality, increased significantly during the trial. No subject experienced toxicity. CONCLUSION: Nandrolone decanoate has beneficial effects on weight, lean body mass and quality of life in selected patients who have mild to moderate HIV wasting.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Demographic pattern of AIDS in Australia, 1991 to 1993. The National HIV Surveillance Committee.

Population-based acquired immune deficiency syndrome (AIDS) incidence in Australia in 1991-1993 was ascertained. The National Centre in HIV Epidemiology and Clinical Research obtained information on AIDS cases from notification by doctors of AIDS diagnoses through the Department of Health in each state and territory. Information on the Australian population, broken down by sex, age group, country of birth and geographic area of residence was obtained from the Australian Bureau of Statistics. To the end of February 1995, 2341 cases of AIDS were reported as having been diagnosed in Australia during 1991-1993. Of these, 96 per cent were in males, of whom over 72 per cent were in the age group 25-44 years. Geographic concentration of AIDS cases was observed: over 55 per cent of cases were in New South Wales (NSW) and these were concentrated in inner Sydney, in particular, in two metropolitan health areas: Eastern Sydney and Central Sydney. Age-standardised average annual incidence per 100,000 population was 8.9 for males, 0.4 for females and 4.6 overall. This incidence varied widely when the population was subdivided by Local Government Area, especially in NSW, where incidence for males varied from 0.0 to 204.4. The highest average annual incidence per 100,000 population by country of birth was recorded for people born in North America, which was almost four times higher than that for people born in Australia. Although AIDS cases diagnosed in 1991-1993 were concentrated on the metropolitan area of capital cities, cases also occurred in rural areas.

Acquired Immunodeficiency Syndrome↗