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Biomedical subjects

J Goldberg

Publications and source records attributed to J Goldberg.

At least 433 records · Page 24Linked to original sources
PubMedDate not supplied

Contribution of emotionally traumatic events and inheritance to the report of current physical health problems in 4042 Vietnam era veteran twin pairs.

OBJECTIVE: To determine the contributions of psychological trauma (exposure to combat during the Vietnam War), genetic factors, childhood experiences shared by twin siblings, and unmeasured experiences not shared by twin siblings to the reporting of current physical health problems a mean of 19 years after military service. METHODS: In 1987, a national sample of 2224 monozygotic and 1818 dizygotic male veteran members of the Vietnam Era Twin Registry participated in a survey of health. Genetic modeling was performed on cross-sectional physical health and combat exposure data derived from Registry twins. RESULTS: Combat experiences explained a small proportion (0.7-8.4%) of the variance in the report of hypertension, respiratory conditions, persistent skin conditions, gastrointestinal disorders, joint disorders, and hearing problems. Childhood experiences shared by siblings are not clearly related to any health problem studied. By contrast, genetic factors explain 31 to 54% and noncombat experiences not shared by siblings explain 45 to 66% of the variance in current physical health status. CONCLUSIONS: Greater than 90% of the variance in reported current physical health problems in Vietnam era veterans is attributable to inherited factors and unmeasured environmental experiences not shared by twin siblings. The traumatic experience of combat makes only a small contribution to the report of current physical health problems. These results do not preclude the possibility that combat influenced the prevalence of illness shortly after military service or that combat may influence the development of illness in the future.

Adult↗
PubMedDate not supplied

A twin study of chronic fatigue.

OBJECTIVE: The etiology of chronic fatigue syndrome is unknown, but genetic influences may be important in its expression. Our objective was to assess the role of genetic and environmental factors in unexplained chronic fatigue. METHODS: A classic twin study was conducted using 146 female-female twin pairs, of whom at least one member reported > or =6 months of fatigue. After completing questionnaires on symptoms, zygosity, physical health, and a psychiatric interview, twins were classified using three increasingly stringent definitions: 1) chronic fatigue for > or =6 months, 2) chronic fatigue not explained by exclusionary medical conditions, and 3) idiopathic chronic fatigue not explained by medical or psychiatric exclusionary criteria of the chronic fatigue syndrome case definition. Concordance rates in monozygotic and dizygotic twins were calculated for each fatigue definition along with estimates of the relative magnitude of genetic and environmental influences on chronic fatigue. RESULTS: The concordance rate was higher in monozygotic than dizygotic twins for each definition of chronic fatigue. For idiopathic chronic fatigue, the concordance rates were 55% in monozygotic and 19% in dizygotic twins (p =.042). The estimated heritability in liability was 19% (95% confidence interval = 0-56) for chronic fatigue > or =6 months, 30% (95% confidence interval = 0-81) for chronic fatigue not explained by medical conditions, and 51% (95% confidence interval = 7-96) for idiopathic chronic fatigue. CONCLUSIONS: These results provide evidence supporting the familial aggregation of fatigue and suggest that genes may play a role in the etiology of chronic fatigue syndrome.

Adult↗
PubMedDate not supplied

Methods for solving nonlinear equations used in evaluating emergency vehicle busy probabilities.

In this paper we present two iterative methods for solving a model to evaluate busy probabilities for Emergency Medical Service (EMS) vehicles. The model considers location dependent service times and is an alternative to the mean service calibration method; a procedure, used with the Hypercube Model, to accommodate travel times and location-dependent service times. We use monotonicity arguments to prove that one iterative method always converges to a solution. A large computational experiment suggests that both methods work satisfactorily in EMS systems with low ambulance busy probabilities and the method that always converges to a solution performs significantly better in EMS systems with high busy probabilities.

Algorithms↗
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Out-of-hospital transfer of trauma patients.

This study examined a large number of demographic, hospital, and medical factors that may influence out-of-hospital transfer for trauma patients. Data from the 1977 and 1978 National Hospital Discharge Survey were used to assemble a case-control data set of injuries (n=4576); cases were defined as transfers out of hospital and controls were discharges to home. Controls were frequency matched to cases based on overall severity, site of the most severe anatomic injury, and age. The analysis estimated the relative risk of transfer associated with different levels of the risk factors by the odds ratio. The analysis was performed twice, once for the full case-control data set and a second time for patients with severe injuries. Of the risk factors examined the only strong, consistent relationships with patient transfer were found for marital status and region of country. Individuals who were not married were at nearly twice the risk of transfer compared with married individuals; likewise patients hospitalized in the western US were twice as likely to be transferred as patients in Southern hospitals. Possible reasons for these results are offered.

Hospitals↗
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Fetal outcome in narcotic-dependent women: the importance of the type of maternal narcotic used.

The records of 239 infants born to 228 women dependent on narcotic drugs were reviewed to determine if type of drug abused and adequacy of prenatal care would affect pregnancy and fetal outcome. Seventy-nine (33%) pregnancies occurred in women in supervised methadone maintenance, 78 (32%) in women on unsupervised methadone maintenance, 49 (21%) in women on street heroin, and 33 (14%) in women who were multiple drug users. Although the presence of withdrawal symptoms did not differ with respect to type of drug abused, the outcome was significantly better in those infants born to women on supervised methadone maintenance as compared to all other groups (p less than 0.001). There was no demonstrable relationship between the number of prenatal visits to the clinic and fetal outcome. A relationship could not be demonstrated between the maintenance dose during pregnancy and the presence of withdrawal symptoms in the infants born to women on supervised methadone maintenance. The findings of the study suggest that supervised methadone maintenance is compatible with an uneventful pregnancy and delivery. Neonatal complications, with the exception of withdrawal, do not appear to differ from that seen among infants born to nondrug dependent women.

Adult↗
PubMedDate not supplied

[Doxycycline-induced esophageal ulcers].

UNLABELLED: Tetracycline is known as one of the antibiotics that induce esophageal ulcers. PURPOSE: Understand how these ulcers may behave and respond to treatment with sucralfate. METHOD: During the last two years we studied all patients complaining of dysphagia and odinophagia with an upper GI endoscopy, who were taking doxycycline in the last few days. All of them discontinued the drug once the diagnosis was done and most of them were treated also with sucralfate, 1 g tid. RESULTS: Eleven patients took doxycycline prescribed for: pelvic inflammatory disease, acne, urinary tract and pulmonary infections. Odinophagia was the most common symptom over the next few days of treatment with some risk factors previously documented, such as taking pills just before bedtime and with a small amount of water. The esophageal ulcers were multiple and located mainly in the middle esophageal third. Symptoms disappeared 3.7 days after the medication was stopped, while those taking sucralfate did not change the period of symptoms. CONCLUSIONS: Physicians must be aware of the doxycycline induced esophageal ulcers and discontinuation of the antibiotic as the main treatment, while sucralfate even though has shown to cover these ulcers, does not change the outcome. Therefore, they must encourage then patients to take the pills with enough liquid, in supine position and have special attention to the elderly and those with any kind of esophageal disease.

Adult↗
PubMedDate not supplied

[Presence of acinar pancreas in reflux esophagitis and Barrett's esophagus].

Pancreatic metaplasia in Barrett's esophagus was originally described by Krishnamurthy et al. They found that these focal clusters of cells resemble pancreatic acinar cells by immunohistochemistry and electron microscopy. Wang et al one year later, described these same cell clusters in normal and inflamed gastroesophageal junction. We studied 318 cases diagnosed as Barrett's esophagus (199 cases) and chronic esophagitis (119 cases) in the ABC Medical Center seen in 1996 and the first four months of 1997, to look for pancreatic acinar metaplasia. We found 14 cases of Barrett's esophagus and 11 cases of chronic esophagitis with pancreatic acinar metaplasia. By immunohistochemistry and electron microscopy that these cell clusters are actually acinar pancreatic cells. Our results are in keeping with those found by Krishnamurthy and Wang that the clusters represent pancreatic acinar cells and may be found in Barrett's esophagus and in chronic esophagitis. The significance of these findings remain to be elucidated.

Adult↗
PubMedDate not supplied

Effect of peritoneal fluid from endometriosis patients on sperm motion characteristics and acrosome reaction.

OBJECTIVE: To determine whether peritoneal fluid from women with endometriosis contributes to infertility by impairing sperm motion and functional characteristics. METHODS: Women with endometriosis (n = 20) underwent laparoscopy for infertility or pelvic pain. Patients undergoing tubal ligation served as controls (n = 14). Peritoneal fluid was aspirated from women with endometriosis, or from women undergoing laparoscopic tubal ligation. Sperm motility, motion characteristics and acrosome reaction were assessed following incubation with peritoneal fluid. RESULTS: Sperm motility, motion characteristics, and acrosome reaction did not differ significantly between the two groups after 3, 5, or 24 hours of incubation with peritoneal fluid. CONCLUSIONS: Sperm motion or functional characteristics showed no significant impairment when sperm from normal donors were incubated with peritoneal fluid from patients with endometriosis. It is unlikely that peritoneal fluid in these patients contributes to infertility.

Acrosome Reaction↗
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Effect of telescopic spectacles on head stability in normal and low vision.

Telescopic spectacles, highly magnifying visual aids mounted in spectacle frames, markedly alter the visual consequences of head movements. To evaluate the effect of this altered visual feedback on head stability, angular head velocity of normally sighted and low vision subjects was measured in the roll, pitch, and yaw axes. Measurements were made under two postural conditions: (1) quiet standing; and (2) walking in place, as well as three visual conditions: (1) eyes closed; (2) unmagnified vision; and (3) vision with 4 x binocular telescopic spectacles. For normal subjects during quiet standing, both unmagnified vision and vision with telescopic spectacles tended to reduce spontaneous head velocity in all axes as compared to the eyes-closed condition. However, in low vision subjects neither unmagnified vision nor vision with telescopic spectacles produced significant changes in values of head velocity relative to those measured with eyes closed. Spontaneous head velocities for standing low vision subjects tended to be higher than in normal subjects, although not all differences were statistically significant. During walking in place, Fourier analysis demonstrated prominent frequency components related to harmonics of the walking frequency under all viewing conditions. In normal subjects, vision with telescopic spectacles, to a greater degree than unmagnified vision, reduced head velocity during walking in the roll and yaw, but not the pitch, axes. For low vision subjects, significant reductions in head velocity during walking were observed only during vision with telescopic spectacles. These findings indicate that vision reduces angular instability of the head during standing and walking. Magnification produced by telescopic spectacles further improves head stability under some conditions, although the effect of vision is least evident in the pitch axis. The stabilizing effect of vision is reduced in low vision subjects.

Adult↗
PubMedDate not supplied

Visual-vestibular interaction with telescopic spectacles.

Vestibularly and visually driven eye movements interact to compensate for head movements to maintain the necessary retinal image stability for clear vision. The wearing of highly magnifying telescopic spectacles requires that such compensatory visual-vestibular interaction operate in a quantitative regime much more demanding than that normally encountered. We employed electro-oculography to investigate the effect of wearing of 2x, 4x, and 6x binocular telescopic spectacles on visual-vestibular interactions during sinusoidal head rotation in 43 normal subjects. All telescopic spectacle powers produced a large, immediate increase in the gain (eye velocity/head velocity) of compensatory eye movements, called the visual-vestibulo-ocular reflex (VVOR). However, the amount of VVOR gain augmentation became limited as spectacle magnification and the amplitude of head velocity increased. Optokinetic responses during wearing of telescopic spectacles exhibited a similar nonlinearity with respect to stimulus amplitude and spectacle magnification. Computer simulation was used to demonstrate that the nonlinear response of the VVOR with telescopic spectacles is a result of nonlinearities in visually guided tracking movements. Immediate augmentation of VVOR gain by telescopic spectacles declined significantly with increasing age in the subject pool studied. Presentation of unmagnified visual field peripheral to the telescopic spectacles reduced the immediate VVOR gain-enhancing effect of central magnified vision. These results imply that the VVOR may not be adequate to maintain retinal image stability during head movements when strongly magnifying telescopic spectacles are worn.

Adaptation, Ocular↗
PubMedDate not supplied

The Vietnam Era Twin Registry: a resource for medical research.

The Vietnam Era Twin Registry consists of 4,774 male-male twin pairs born between 1939 and 1957 with both brothers having served in the United States military during the Vietnam War. The registry was originally developed to provide the best control group for Vietnam-exposed servicemen to study the long-term health consequences of service in Vietnam. Recognizing the potential value of the registry for other areas of medical research, the Department of Veterans Affairs in 1988 opened the registry for use by both VA and non-VA investigators. The existence of centralized VA data bases for deaths and VA hospitalizations will strengthen future followup of the twins. This article describes the characteristics of the registry population and the process for accessing the registry.

Adult↗
PubMedDate not supplied

Voluntary modification of the rotatory induced vestibulo-ocular reflex by fixating imaginary targets.

Voluntary enhancement and suppression of the vestibulo-ocular reflex (VOR) was investigated in 12 normal subjects aged 23-74. Eye movements were recorded using DC electrooculography in response to two patterns of horizontal rotation: single-frequency sinusoids in the 0.05-0.8 Hz frequency range; and pseudorandom waveforms consisting of a sum of sinusoids in the 0.05-0.35 Hz range. Subjects were able to significantly alter the gain and phase of their VOR responses by fixating imaginary targets in both patterns of stimulation. The amount of VOR modification decreased as the frequency of stimulation increased but was not correlated with age. In the clinical setting, potential voluntary alteration of the VOR must be considered in judging the normality of a subject's responses.

Adult↗
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Continuous high-energy low-flow-rate enteral support: a panoramic review of 1000 cases.

One thousand intensive care digestive surgical cases are reviewed concerning continuous low-flow-rate enteral support (CLFRES), using Nutripompe: 607 males and 393 females, average age 51 years. The average duration of CLFRES is 21.5 days +/- 13, range 4 to 180 days. CLFRES was used postoperatively in 76 per cent, preoperatively in 10 per cent, and pre- and postoperatively in 14 per cent of cases, respectively. The enteral support route was 63 per cent nasogastric, 20 per cent gastrostomy and 17 per cent jejunostomy. Five hundred and ten patients required extensive digestive surgery with temporary exclusions. More than 100 patients with either temporary enterostomies or enterocutaneous fistulas have had continuous reinstillation of digestive chyme (CRDC) associated with their intensive care unit treatment management. CRDC in the lower end of an enterostomy has shown a specific retrograde inhibitory effect on the upper digestive secretions, particularly on the intestinal secretions during pathologies associated with one or several interruptions of the continuity of the gastrointestinal tract. This technique and its physiological implications were discussed. The principal pathologies in this important study group are: severe digestive fistulas, 24 per cent; acute diffuse peritonitis, 18 per cent; acute enterocolitis, 14 per cent; digestive tumours, 35 per cent; and acute necrotizing haemorrhagic pancreatitis, 9 per cent. A comparative analysis of nutritional energy nitrogen requirement was presented in view of the cancer, the septic, and the non-cancer non-septic patient groups. Enteral support nutritional solutions were primarily mixed non-degraded food, 70 per cent, and semi-elemental diets, 30 per cent. Certain pathology groups required variations in protein and lipid percentage. An up-to-date evaluation of nutritive formulas based on small peptides in normal and small bowel postoperative patients was discussed. Four CLFRES administration programmes were discussed: normal gastrointestinal tract, 38 per cent; abnormal gastrointestinal tract, 44 per cent; pancreatitis, 11 per cent; short bowel, 7 per cent. Nutrition evolution parameters (clinical), were: weight gain curve (minimum 10 days), local regional healing, biological positive changes in protein metabolism, nitrogen balance, lipid metabolism and glucose regulation. Impact on complications such as thrombosis, embolism and haemorrhage were discussed. Clinical and biological results using CLFRES were most satisfactory in more than 90 per cent of patients.

Adolescent↗
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Acute leukemia presenting with myeloid and lymphoid cell markers.

A case is described of acute leukemia whose neoplastic cells possessed myeloid and lymphoid characteristics. Neoplastic cells possessed cytoplasmic granules containing Sudan black B material and diaminobenzidine myeloperoxidase. In addition, these luekemic cells were positive for terminal deoxynucleotidyl transferase. Ia antigen, and the common acute lymphocytic leukemia antigen. These findings indicate that biphenotypic cell markers may exist in cases of acute leukemia. It is our belief that these results are best explained as either a mixed myeloid-lymphoid leukemia or a stem cell leukemia capable of differentiating into myeloid and lymphoid cells.

3,3'-Diaminobenzidine↗
PubMedDate not supplied

Nailfold capillary microscopy: a new technique for finger systolic pressure measurement.

To assess the value of nailfold capillary microscopy (N.C.M.) for measuring finger systolic pressure (F.S.P.), 25 patients were studied by N.C.M. and plethysmography. Twelve of them presented Raynaud's phenomenon. The results revealed that N.C.M. can be correlated with plethysmography for measuring F.S.P. Therefore, N.C.M. with F.S.P. measurement is a practical, inexpensive method, and provides an additional microvascular diagnostic evaluation.

Adult↗