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Biomedical subjects

J Goldsmith

Publications and source records attributed to J Goldsmith.

At least 73 records · Page 4Linked to original sources
PubMed1990

Interruption of critical aortoiliac collateral circulation during nonvascular operations: a cause of acute limb-threatening ischemia.

In patients with aortoiliac occlusive disease interruption of critical collaterals during another nonvascular or cardiac operation may threaten limb viability. This occurred in four patients whose limb-threatening ischemia was precipitated by radical cystectomy with bilateral hypogastric artery ligation, left colon resection, or coronary artery revascularizations by means of the internal mammary artery. Important collateral pathways, the interruption of which may account for this phenomenon, are detailed, and approaches are outlined for prevention and management of acute ischemia in this setting.

Acute Disease↗
PubMed1990

Changing arteriosclerotic disease patterns and management strategies in lower-limb-threatening ischemia.

From January 1, 1974 to December 31, 1989, we treated 2829 patients with critical lower-extremity ischemia. In the last 5 years, 13% of patients had therapeutically significant stenoses or occlusions above and below the groin, while 35% had them at two or three levels below the inguinal ligament. Unobstructed arterial flow to the distal half of the thigh was present in 26% of patients, and 16% had unobstructed flow to the upper third of the leg with occlusions of all three leg arteries distal to this point and reconstitution of some patent named artery in the lower leg or foot. In the last 2 years, 99% of all patients with a threatened limb and without severe organic mental syndrome or midfoot gangrene were amenable to revascularization by percutaneous transluminal angioplasty (PTA), arterial bypass, or a combination of the two, although some distal arteries used for bypass insertion were heavily diseased or isolated segments without an intact plantar arch. Limb salvage was achieved and maintained in more than 90% of recent patient cohorts, with a mean procedural mortality rate of 3.3%. Recent strategies that contributed to these results include (1) distal origin short vein grafts from the below-knee popliteal or tibial arteries to an ankle or foot artery (291 cases); (2) combined PTA and bypass (245 cases); (3) more distal PTA of popliteal and tibial artery stenoses (233 cases); (4) use of in situ or ectopic reversed autogenous vein for infrapopliteal bypasses, even when vein diameter was 3 to 4 mm; (5) composite-sequential femoropopliteal-distal (PTFE/vein) bypasses; (6) reintervention when a procedure thrombosed (637 cases) or was threatened by a hemodynamically significant inflow, outflow, or graft lesion (failing graft, 252 cases); (7) frequent follow-up to detect threatening lesions before graft thrombosis occurred and to permit correction of lesions by PTA (58%) or simple reoperation; and (8) unusual approaches to all infrainguinal arteries to facilitate secondary operations, despite scarring and infection. Primary major amputation rates decreased from 41% to 5% and total amputation rates decreased from 49% to 14%. Aggressive policies to save threatened limbs thus are supported.

Amputation, Surgical↗
PubMed1990

Partial monosomy for chromosome 22 in a patient with del(22)(pter----q13.1::q13.33----qter).

An 18 month old girl with partial monosomy for the long arm of chromosome 22 is described. The karyotype was 46,XX,del(22)(pter----q13.1::q13.33----qter). To our knowledge this is the first report of monosomy for this specific segment of chromosome 22. Clinical features include developmental delay in all areas, hypotonia, macrosomia, full cheeks, eyebrows, and eyelids, mild epicanthus, wide nasal bridge, long philtrum, and thick lower lip. Parental chromosome studies were normal.

Chromosome Aberrations↗
PubMed1990

Immunohistochemistry of Pneumocystis carinii infection.

Pneumocystis carinii is the pre-eminent pulmonary pathogen and leading cause of death in patients with acquired immunodeficiency syndrome (AIDS). The diagnosis of this organism depends upon the morphologic demonstration of the cyst wall, trophozoite, or sporozoite in specimens from the lower respiratory tract. A variety of histochemical stains have been used to identify P. carinii, each with considerable limitations in specificity. Extrapulmonary spread and unusually destructive pulmonary patterns associated with P. carinii, although once considered rare, are seen occasionally in patients with AIDS. Traditional stains have proven to be less reliable in extrapulmonary sites. In 13 patients with AIDS, we stained formalin-fixed paraffin-embedded autopsy lung and other visceral organ sections using monoclonal antibody 3F6 (Dako, Santa Barbara, CA) to P. carinii. The antibody stained P. carinii in the lungs of seven patients with P. carinii pneumonia by Gomori methenamine silver stain (GMS). Numerous aggregates of P. carinii cysts were marked within alveoli, as is usually seen with other stains. No antibody staining was present in autopsy lung sections from non-AIDS patients with viral, fungal, or bacterial pneumonia. Clinically occult extrapulmonary P. carinii infection was seen in 4/7 (57%) patients with P. carinii pneumonia at autopsy. Monoclonal antibody to P. carinii stained organisms in all four (100%) patients with disseminated disease, as compared with 1/4 (25%) staining with GMS. Antibody staining of P. carinii was demonstrated in sections of thyroid, adrenal, and carinal lymph node (one patient), esophagus (one patient), kidney (one patient), and heart, thyroid, kidney, adrenal, liver, stomach, pancreas, spleen, and bone marrow (one patient).(ABSTRACT TRUNCATED AT 250 WORDS)

Acquired Immunodeficiency Syndrome↗
PubMed1989

Augmentation of natural cytotoxicity by leucine enkephalin in cultured peripheral blood mononuclear cells from patients infected with human immunodeficiency virus.

Natural Killer (NK) activity of lymphocytes from acquired immunodeficiency syndrome (AIDS) patients is frequently below normal and declines as disease progresses. We studied the potential of leucine enkephalin (leu-enkephalin) to restore this immune parameter by incubating nylon wool nonadherent mononuclear cells from 14 patients in the presence or absence of leu-enkephalin, and measuring NK cytolysis in a standard 51Cr release assay. The NK activity of human immunodeficiency virus antibody positive (HIV+) individuals with some remaining NK lytic ability was significantly augmented by leu-enkephalin concentrations of 10(-10) and 10(-8) M (n = 7). HIV+ patients with no measurable basal level of NK activity (n = 3) were not responsive to stimulation with leu-enkephalin. Human immunodeficiency virus antibody negative (HIV-) individuals (n = 4) responded in a pattern similar to normals. In addition, naloxone, an antagonist of alkaloid and peptide opiates including leu-enkephalin, displayed the properties of an antagonist/agonist, reflecting the immunoregulatory capacities of the endogenous opiate system.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Resting gated pool ejection fraction: a poor predictor of perioperative myocardial infarction in patients undergoing vascular surgery for infrainguinal bypass grafting.

Ventricular ejection fraction is widely regarded as a prognostic indicator of perioperative myocardial infarction. To evaluate this premise the prevalence of perioperative myocardial infarction or cardiac death was analyzed in relation to preoperative resting gated pool ejection fraction in 85 patients undergoing vascular surgery for infrainguinal bypass grafting. Patients were divided into three groups on the basis of ejection fraction. Group I consisted of 50 patients with ejection fractions of 56% to 92%. Nine (18%) perioperative myocardial infarctions occurred in group I, and there were no cardiac deaths. Group II consisted of 20 patients with ejection fractions of 37% to 55%. Three (15%) myocardial infarctions occurred in this group, and there were no cardiac deaths. Group III included 15 patients with ejection fractions of 20% to 35%. Three (20%) cardiac events occurred in group III including one nonfatal myocardial infarction and two (13%) cardiac deaths. Statistical analysis showed no significant difference in prevalence of cardiac events between any group. These results suggest that resting ejection fraction is a poor predictor of perioperative myocardial infarction in patients undergoing vascular surgery. Patients with normal ejection fractions, but underlying coronary artery disease, are still at significant risk for a perioperative cardiac event.

Adult↗
PubMed1989

Clustering of strokes in association with meteorologic factors in the Negev Desert of Israel: 1981-1983.

Clinical observations of the apparent clustering of daily stroke admissions to a regional hospital in an arid climate prompted our investigation of possible meteorologic factors associated with stroke admissions. Daily hospitalization and meteorologic data were studied for 895 patients with stroke admitted to Soroka Medical Center, Beer-Sheva, Israel, during 1981, 1982, and 1983. The average daily incidence of stroke was about twice as great on relatively warm days as on relatively cold ones. This increase may be explained by increases in thromboembolic mechanisms secondary to physiologic changes in response to heat. When heat waves are predicted, information on the added risk for stroke needs to be disseminated to both the population and to health care providers so preventive measures can be instituted. Special attention should be devoted to air conditioning and adequate consumption of liquids, and antiplatelet aggregation medication such as aspirin should be considered.

Atmospheric Pressure↗
PubMed1988

Prognostic usefulness of the Walter Reed staging classification for HIV infection.

We evaluated the usefulness of both the Walter Reed (WR) staging classification and the component criteria used in the system in predicting progression to AIDS. The WR classification was applied to a cohort of 431 men who were seropositive for the human immunodeficiency virus on entry into a prospective study. The WR classification was of limited usefulness, as only 133 men (31%) could be assigned to a WR stage. Among men who could be WR classified, only individuals in WR stage 5 were found to have a significantly more rapid progression to AIDS. The seropositive cohort was also classified based on initial CD4 cell number. Low CD4 counts (less than 400 cells/mm3) were significantly associated with progression to AIDS, and grouping seropositive men by CD4 number alone provided as much prognostic information as the WR classification. Skin test anergy was also a significant predictor for progression to AIDS, but only in individuals with low CD4 counts.

Acquired Immunodeficiency Syndrome↗
PubMed1988

A technique for donor lung procurement and preservation for transplantation after completion of cardiac donation.

The scarcity of donor lungs for transplantation has been caused, in part, by the belief that a single donor cannot provide usable lungs if it serves as a heart donor. However, the appropriate division of the left atrial wall provides sufficient cuffs for individual transplantation of the heart and each lung into three separate recipients. With the described technique, the results of the present studies demonstrate the feasibility of donor lung procurement and preservation for transplantation after cardiac donation. Use of this method will allow the most effective and efficient use of the limited supply of donor organs and thereby permit therapeutic single lung transplantation in selected patients. Cardiac donation should no longer preclude lung donation as it has in the past.

Animals↗
PubMed1987

Partial monosomy 12p13.1----13.3.

We describe a 27 month old female child with partial monosomy for the short arm of chromosome 12: 46,XX,del(12)(p13.1----p13.3). She differs from the eight cases described by others, in that she is less severely affected. Her main clinical features are developmental delay, protruding tongue, strabismus, slightly unusual facies, slight micrognathia, and speech delay.

Child, Preschool↗