Biomedical subjects
Publications and source records attributed to J Goldstein.
In this paper the interrelation between several biochemical and physical parameters and liver pathology determined in morbidly obese patients who underwent a Rouxen-Y gastric bypass are described.
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Little data have been accumulated on the health care problems of underserved, urban Hispanic-Americans. The purpose of this study was to determine the prevalence of hypertension and the adequacy of treatment for Hispanic-Americans (predominately Puerto Ricans) and blacks living in the South Bronx section of New York City.Almost three fourths (74.5 percent) of the study subjects (n = 145) knew what hypertension was, and 40.7 percent said they had hypertension. However, 52.3 percent of subjects (Hispanic, 49.2 percent and black, 61.5 percent) who responded that they were not hypertensive had hypertension. Of those who said they had hypertension, only 55.9 percent were taking medication (Hispanic, 57.5 percent and black, 57.1 percent). For those taking medication, the majority did not have their hypertension controlled (Hispanic, 78.2 percent and black, 100 percent).These data suggest that for urban Hispanics and blacks, both hypertensive awareness and control is poor. This population thus appears likely to suffer excess morbidity and mortality from hypertension. Public policy programs for surveillance and control of hypertension in urban Hispanic and black populations may decrease the rate of morbidity and mortality from this treatable disease.
Multicolored corneal endothelial pigment was noted in patients on routine specular microscopy, confirming the presence of chromatic pigment deposits at the corneal endothelium. These deposits were polychromic, exhibiting blue, green, red, pink, orange, gold, and yellow colors. These pigment deposits were of different sizes and shapes and often seemed to surround darkened cells or clusters of cells. The variations in color may be the result of differing concentrations of melanin in iris or other pigmented cells that adhere to the posterior surface of the corneal endothelium. To our knowledge, this is the first report of the observation of polychromic endothelial pigment. We encourage the use of color film for specular microscopy to help detect and identify this pigment further.
Reported here is a case of primary adenosquamous carcinoma of the common bile duct. This unusual variant of the ordinary adenocarcinoma has not, to the best of our knowledge, been previously reported as occurring in the extrahepatic bile ducts. A tumor of notorious prognostic significance, it represents an exceedingly rare and peculiar biological phenomenon of malignant metaplastic change.
Prostacyclin (PGI2) has been shown to present myocardial protective effects which could be beneficial during cardiac arrest. We tested this hypothesis in a closed-chest dog model in which electromechanical dissociation (EMD) can be predictably observed after 90 to 120 seconds of ventricular fibrillation without chest compression. Six dogs were pretreated with a PGI2 infusion at a rate of 1 mcg/kg/min and six other dogs served as control animals. After 60 seconds of ventricular fibrillation, EMD was already observed in 3 PGI2-treated dogs but in no control dog. After 90 seconds of ventricular fibrillation, EMD was present in 2 PGI2-treated dogs and in 2 control dogs, so that 4 control but only one PGI2-treated animal survived after 90 seconds of ventricular fibrillation. Ventricular defibrillation was also not facilitated in PGI2-treated dogs. The present study does not support PGI2 administration in cardiopulmonary resuscitation.
The case of a patient who presented clinically with hemoptysis and was shown to have bilateral pulmonary infiltrates and renal abnormalities is described. This typical clinical setting was initially diagnosed as Goodpasture's syndrome. Open biopsies of lung and kidney were performed. Light microscopy failed to demonstrate the renal abnormalities most often associated with Goodpasture's syndrome. Immunofluorescence and electron microscopic findings were compatible with a diagnosis of immune complex glomerulonephritis. No immunologic lesions were demonstrated by lung biopsy. Antiglomerular basement membrane antibodies were not detected in the patient's serum. In view of the drastic prognostic and therapeutic consequences of Goodpasture's syndrome, it is essential that this diagnosis be confirmed by tissue examination and serologic testing.
Early open reduction and internal fixation (ORIF) of extremity fractures in patients with multiple injuries has been demonstrated to be safe, improve survival, and decrease the incidence of respiratory failure. Complications leading to abandonment of planned operative fixation and death in several patients with pelvic fractures led us to initiate a policy of early ORIF of the disrupted pelvic ring. Early ORIF of the pelvis was performed in 15 multiply injured patients between May 1984 and August 1985. Patients ranged in age from 13 to 79 years, their Hospital Trauma Index-ISS scores ranged from 14 to 68, and number of preoperative transfusions ranged from 0 to 42. Types of fractures were A-P compression, two, lateral compression, one, vertical shear, seven, complex, two, and acetabulum with ring disruption, three. All patients were resuscitated, transported in pneumatic antishock garments, and evaluated by abdominal and pelvic CT scan (in two patients following celiotomy). Preoperative angiograms to assess retroperitoneal hemorrhage in eight patients resulted in identification and control of significant bleeding in five. The mean time from injury to pelvic stabilization was 38 hours. Seven patients underwent ORIF within the first 24 hours. In most cases simultaneous anterior and posterior internal fixation was performed with the patient in the lateral decubitus position. Excluding associated procedures, operative time averaged 5.1 hours. Intra-operative transfusions averaged 4 units (range, 0-11). Rigid fixation was achieved in all patients. Most patients were out of bed by the third postoperative day. No patient developed respiratory failure. Two patients developed wound infections. Modification of our technique has avoided this complication in the latter part of this series.(ABSTRACT TRUNCATED AT 250 WORDS)
A systemic disorder characterized by fever and reactive lymphadenopathy developed in a patient with scabies infestation. Regression of all clinical symptoms and signs occurred after antiscabies therapy. Two months later, the whole clinical picture reappeared concomitantly with scabies reinfestation. Subsequent lymph node biopsy demonstrated typical angioimmunoblastic lymphadenopathy (AILD). It is plausible that persistent antigenic stimulation caused by scabies infection was of pathogenetic importance in the induction of the syndrome of AILD. Infectious agents should be considered and looked for in patients with AILD, since they may play a role in the evolution of this disease.
The side-effect profile of labetalol was assessed in 34 patients with mild to moderate essential hypertension who had previously experienced side effects during beta-blocker therapy. The most frequently reported beta-blocker side effects were fatigue, impotence, cold extremities, and depression. After discontinuing their previous beta-blocker for 4 weeks, labetalol was titrated (100-400 mg b.i.d.) to achieve blood pressure control. Twenty-seven of 34 patients did not have a recurrence of a beta-blocker related side effect while receiving labetalol. The most common new side effect with labetalol was dizziness (3 patients). As judged by the attending physician and the patient, labetalol was better tolerated than conventional beta-blocker therapy in 30 of 34 patients (88%). Twenty-four of 34 patients (71%) preferred labetalol over previous therapy. Labetalol controlled blood pressure in 30 of 34 patients (88%). At equal antihypertensive doses, some side effects common to beta-blockers are seen less frequently with labetalol.
We report the case of a 66-year-old postmenopausal woman who underwent unilateral oophorectomy for an ovarian endometrioid carcinoma with an unusual adenofibromatous stromal reaction pattern. She is presently alive, well and without clinical evidence of tumour two years after surgery. Adenofibromatous or cystadenofibromatous reaction is a peculiar reactive ovarian stromal change most probably induced by the invading neoplastic epithelial cells. No definite conclusions have been reached regarding the prognostic significance of this special stromal tissue reaction in cases of endometrioid carcinoma of the ovary.
We report on a previously apparently unreported syndrome of distichiasis with congenital heart defects and with mixed peripheral vascular anomalies in a mother and her four children. The mother had a ventricular septal defect; both daughters had surgery for patent ductus arteriosus. Sinus bradycardia alone (elder son), with stress induced asystole (younger son), and with wandering atrial pacemaker (both daughters) are documented electrocardiographically. Three of the five have edema, two have visible varicosities, three have symptoms consistent with chronic venous disease of the legs, and the older daughter has complaints consistent with arterial disease in the legs. Doppler flow studies demonstrated post-phlebitic syndrome in all but the younger daughter, and vasospastic disease in the mother, older daughter, and second son.
Primary benign vascular tumors of lymph nodes are very rare. Various forms of lymph nodal vascular transformations defined as hemangiomatoid lesions, pannodal vasodilatation, or nodal angiomatosis have been described. We present a patient who was thought to have an epithelial salivary gland tumor, but instead was found to have an hemangioendothelioma of an adjacent enlarged lymph node in the region of the left submandibular gland.
Local infiltration of adjacent anatomic structures and soft tissues of the neck from well-differentiated carcinoma of the thyroid gland is a relatively infrequent occurrence. We report our experience with 21 such cases seen in our department over the past 20 years. All patients were treated by total thyroidectomy and total or partial excision of the infiltrated adjacent structures. Papillary carcinoma was the most frequent type of primary tumor seen. Following the definitive surgery, all patients were scanned with radioactive iodine (131I). In case of isotope entrapment, a curative dose 131I was given. All patients in our series were required to receive thyroid hormone replacement. Four patients died as a result of their disease. Uncontrolled local disease and distant metastases were present at the time of death. Three patients died of unrelated causes. Two-thirds of the patients are still alive (from 1 to 19 years after the treatment).
The incidence of hypophosphatemia during the first 48 h following cardiothoracic surgery was prospectively studied in 74 patients. Hypophosphatemia, defined by a serum phosphate below 2.50 mg/dl, was observed in 19 of 34 (56%) patients after thoracic surgery and in 20 of 40 (50%) patients after cardiac surgery. As a whole, hypophosphatemia occurred earlier after thoracic than after cardiac surgery. After thoracic surgery, hypophosphatemia was milder for patients in whom bleeding was more severe. The anticoagulant solution CPD used in stored blood was identified as an important source of phosphate. These results indicate hypophosphatemia is a common finding after cardiothoracic surgery. Since severe hypophosphatemia can be related to phosphate depletion, phosphate supplements could be warranted especially during thoracic surgery when blood transfusions are less than 1000 ml.
Cell solute composition and apparent intracellular ionic concentrations (subscript i) were determined in rectal gland slices of the dogfish shark (Squalus acanthias). On aerobic incubation in elasmobranch Ringer's at 15 degrees C, the steady state values were: Ki+, 151 mM, close to its apparent electrochemical equilibrium; Cai2+, 1.7 mM; Mgi2+, 7.5 mM; Cl1-, 97 mM (maintained against its electrochemical potential gradient); the sum (Nai+ + Ki+) was about 66 meq/kg cell water lower than in the medium. Of free amino acids, only the effectively impermeable anionic taurine (32 mM) and glutamate (3.7 mM) significantly contribute to the Donnan system. Variations of the Ringer's K+ concentrations, or the presence of 0.5 mM ouabain, demonstrated the permeability of the cell membrane to na+, K+, and Cl-. Cell volume changes: 0.5 mM ouabain produced a gradual swelling and ionic changes consistent with an inhibition of the sodium pump. In high-K+ media the cells swelled massively and the membrane depolarized. A linear relationship between cell volume changes and the Nernst potential for K+ was found. These properties are consistent with a pump-and-leak system for cell volume maintenance. The K+ -induced cell swelling was found to be reversible on transfer of the tissue to regular Ringer's. The extrusion of cell water was associated with an influx of Na+ into, and an efflux of K+ from, the cells (both fluxes down-hill), as well as extrusion of Cl- against its concentration gradient.2+
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