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Biomedical subjects

J Goldstein

Publications and source records attributed to J Goldstein.

At least 271 records · Page 15Linked to original sources
PubMed1985

Coronary angiographic morphology in myocardial infarction: a link between the pathogenesis of unstable angina and myocardial infarction.

It has previously been shown that analysis of coronary morphology can separate unstable from stable angina. An eccentric stenosis with a narrow neck or irregular borders, or both, is very common in patients who present with acute unstable angina, whereas it is rare in patients with stable angina. To extend these observations to myocardial infarction, the coronary morphology of 41 patients with acute or recent infarction and nontotally occluded infarct vessels was studied. For all patients, 27 (66%) of 41 infarct vessels contained this eccentric narrowing, whereas only 2 (11%) of 18 noninfarct vessels with narrowing of 50 to less than 100% had this lesion (p less than 0.001). In addition, a separate group of patients with acute myocardial infarction who underwent intracoronary streptokinase infusion were also analyzed in similar fashion. Fourteen (61%) of 23 infarct vessels contained this lesion after streptokinase infusion compared with 1 (9%) of 11 noninfarct vessels with narrowing of 50 to less than 100% (p less than 0.01). Therefore, an eccentric coronary stenosis with a narrow neck or irregular borders, or both, is the most common morphologic feature on angiography in both acute and recent infarction as well as unstable angina. This lesion probably represents either a disrupted atherosclerotic plaque or a partially occlusive or lysed thrombus, or both. The predominance of this morphology in both unstable angina and acute infarction suggests a possible link between these two conditions. Unstable angina and myocardial infarction may form a continuous spectrum with the clinical outcome dependent on the subsequent change in coronary supply relative to myocardial demand.

Angina Pectoris↗
PubMed1985

Detection of endocarditis-associated perivalvular abscesses by two-dimensional echocardiography.

The development of a perivalvular abscess as a complication of infective endocarditis adds appreciably to the expected morbidity and mortality of patients, but such abscesses are seldom recognized by available noninvasive techniques. Therefore, two-dimensional echocardiographic findings in 22 patients with perivalvular abscess found at surgery or necropsy were compared with those in 24 patients without abscess in a retrospective but blinded study. Forty-six valves were examined (31 aortic and 15 mitral, 35 prosthetic and 11 native); 4.0 +/- 2.4 days (range 0 to 7) elapsed between echocardiography and surgery or necropsy. Patients with perivalvular abscess had a somewhat higher incidence of serious complications (emergency repeat valve replacement or death) than did patients with endocarditis alone (63 versus 35%, respectively, p less than 0.05). No single echocardiographic finding was frequently seen with a perivalvular abscess. A "typical" echo-free abscess was noted in only one patient; however, the presence of one or more of the following had a positive predictive value of 86% and a negative predictive value of 87% for the presence of perivalvular abscess: prosthetic valve rocking; sinus of Valsalva aneurysm, anterior aortic root thickness of 10 mm or greater, posterior aortic root thickness of 10 mm or greater or perivalvular density in a septum of 14 mm or greater. These predictive values, of course, apply only to patients with infective endocarditis going to surgery, and may assist the surgeon in knowing whether or not to expect an abscess.(ABSTRACT TRUNCATED AT 250 WORDS)

Abscess↗
PubMed1985

Calcium metabolism in uremic nephrocalcinosis: preventive effect of verapamil.

The aim of the present study was to examine calcium metabolism of the renal cortex in experimental chronic renal failure, together with morphologic criteria of nephrocalcinosis and to determine the effect of chronic verapamil administration on these parameters. In subtotally nephrectomized (SNX) rats 3 weeks after surgery, renal cortical calcium content increased more than two-fold. 45Ca incorporation into renal cortical slices in SNX revealed a 35% increase, associated with a 50% increase in a lanthanum-resistant fraction of 45Ca uptake. Radiocalcium wash-out curves in this group demonstrated abnormal retention of the isotope for up to 30 min of incubation. In contrast, radiocalcium incorporation and wash-out in SNX rats chronically treated with verapamil were similar to that obtained in the sham group. Verapamil administration significantly reduced, but did not normalize, renal cortical calcium content. Von Kossa staining demonstrated the deposition of calcium in the renal parenchyma of SNX rats. Ultrastructurally, it was accompanied by mitochondrial disorganization and calcification, as well as by the tubular basement membrane destruction and mineralization. These morphologic patterns of nephrocalcinosis were significantly ameliorated in SNX rats treated with verapamil. We conclude that chronic verapamil administration results in amelioration of uremic nephrocalcinosis.

Animals↗
PubMed1985

Myxoma of the nerve sheath. Report of three cases, observations by light and electron microscopy and histochemical analysis.

Findings by light and electron microscopy and histochemistry in three cases of myxoma of a nerve sheath are presented. The histochemical findings are compared with those obtained in identical studies done on two benign schwannomas, two neurofibromas, and a soft tissue myxoma. In addition, myxomatous changes in a peripheral nerve obtained at vagotomy were similarly studied. Morphologically, myxoma of the nerve sheath is a distinct neoplastic entity showing moderate cellular atypia and a characteristic tissue distribution. Histochemically, the neoplasm shows a mucopolysaccharide profile that categorizes it as a neoplasm of mesenchymal origin rich in highly sulfated acid mucins. Of particular note is its close histochemical similarity to a neurofibroma.

Adult↗
PubMed1985

Sodium warfarin-induced gangrene of the breast.

Sodium warfarin is one of the most commonly used oral anticoagulants. It is not without complications. A case is presented of a 56-year-old woman on well-regulated sodium warfarin therapy who suffered unexplained necrosis and gangrene of the breast. She underwent total mastectomy for debridement because of the extensive nature of the infarction. Possible pathophysiological mechanisms for this process are discussed.

Breast↗
PubMed1985

Effects of murine tumor necrosis factor on Friend erythroleukemic cells.

Tumor necrosis inducing factor (TNF), a 140,000 molecular weight glycoprotein present in the serum of Corynebacterium parvum endotoxin-treated mice, was cytotoxic toward Friend virus-transformed erythroleukemic cells (FELC). These cells grow in culture as undifferentiated pro-erythroblasts but can be induced to differentiate in a limited fashion along the erythroid pathway to orthochromatic normoblasts by various agents such as dimethylsulfoxide (DMSO). Partially and highly purified preparations of TNF were cytotoxic toward logarithmically growing FELC whereas a comparable serum protein fraction from C. parvum treated mice or endotoxin from E. coli had no effect upon FELC viability. DMSO-induced cells were more sensitive to the action of TNF requiring only about half the concentration needed to produce 50% kill in noninduced cells. Inhibition of hemoglobin formation was TNF dose-related and could be decreased by 94%. TNF was also cytotoxic toward DMSO-induced cells in stationary phase and mitomycin C treated noninduced FELC. Neuraminidase modification of the surface of FELC increased the cytotoxicity of TNF by 50%. These results demonstrate that TNF destroys FELC whether they are nondividing, dividing or partially differentiated and suggest that TNF may accomplish this by affecting cell metabolism after internalization.

Animals↗
PubMed1985

Antitumor activity of normal human globulin: effects on murine and human erythroleukemic cells.

The effect of the antitumor fraction isolated from the alpha 2-globulin region of normal human serum (NHG-I) upon murine (FELC) and human (K562) erythroleukemic cells in vitro was determined. NHG-I inhibited the growth of both actively growing FELC and K562 cells in a dose-dependent manner. However, it has no effect upon mitomycin C treated FELC which were unable to divide nor upon dimethylsulfoxide-induced FELC in stationary phase. These results indicate that NHG-I has a cytostatic effect upon cell growth and suggests that its action may be dependent upon DNA synthesis. This is in marked contrast to TNF, the alpha 2-globulin factor obtained from murine serum which is also not species-specific but whose action upon these cell lines is cytotoxic.

Alpha-Globulins↗
PubMed1985

Cyclosporine nephropathy after heart and heart-lung transplantation.

Cyclosporine nephrotoxicity after heart transplantation can lead to acute renal failure requiring haemodialysis. In four long-term heart-transplant survivors, cyclosporine nephropathy was characterised by extensive fibrosis, with uraemia, hypertension and/or anaemia. In contrast, the long-term survivor of heart-lung transplantation who had received her graft for accelerated respiratory failure, did not develop chronic renal disease. Thus, chronically reduced renal perfusion before heart transplantation may play a critical role in the development of chronic cyclosporine nephropathy.

Adult↗
PubMed1985

Combined heart-lung transplantation for terminal pulmonary lymphangioleiomyomatosis.

Combined heart-lung transplantation with cyclosporine is reported in a 26-year-old patient who presented with end-stage pulmonary lymphangioleiomyomatosis. The operation was successful and the patient's rehabilitation excellent over the first 7 postoperative months. She then developed obliterative bronchiolitis of unknown origin. To our knowledge, this is the first published report of an out-hospital survival after heart-lung transplantation for terminal nonvascular lung disease.

Adult↗
PubMed1985

Minnesota Multiphasic Personality Inventory: comparison of patients accepting and rejecting myopia surgery.

The Minnesota Multiphasic Personality Inventory (MMPI) was administered to 36 consecutive patients presenting to one surgeon as candidates for myopia surgery. Twenty-one patients proceeded to surgery, and 15 did not. The patients in this series were mature, nonaggressive persons whose basic and clinical MMPI scale values were generally within normal limits. No significant differences were found between the group that underwent surgery and the group that did not. In the group that underwent surgery, no personality characteristics were found to be associated with either a good or a poor surgical result. To our knowledge, this is the first report of the use of the MMPI to objectively evaluate personality characteristics of candidates for myopia surgery.

Adult↗
PubMed1985

Papillary carcinoma and the solitary autonomously functioning nodule of the thyroid.

We report three patients with thyrotoxicosis due to solitary autonomously functioning thyroid nodules, which at surgery were found to contain papillary carcinoma. Despite the rarity of this concurrence we suggest that it may be useful to employ fine-needle aspiration cytology in the evaluation of the solitary autonomously functioning thyroid nodules.

Adult↗
PubMed1984

Functional importance of coronary collateral vessels.

Angiographically demonstrable coronary collateral vessels are believed to preserve myocardial function at rest, but disagreement exists regarding the importance of collaterals in mitigating exercise-induced ischemic dysfunction. Therefore, we used radionuclide cineangiography during exercise to assess the left ventricular (LV) functional effects of collateral vessels in 125 patients with at least 1 major coronary artery that had greater than or equal to 90% diameter stenosis but without prior myocardial infarction. Regional LV function, graded on a 4-point scale, worsened during exercise by at least 1 grade in 14 of 43 regions (33%) with good collaterals, and in 70 of 98 without good collaterals (p less than 0.001). Of the 43 good collaterals, 14 were supplied by arteries with greater than or equal to 75% stenoses; 10 of 14 regions (71%) thus supplied worsened by at least 1 grade (p less than 0.01). The ischemia-mitigating effect of coronary collateral vessels also affected the magnitude of exercise-induced global dysfunction. Of 43 patients with only one greater than or equal to 90% stenotic artery, 18 had good collaterals; in these patients, average LV ejection fraction (EF) at rest was 51 +/- 8%; LVEF during exercise was 46 +/- 7%. In the 25 patients without good collaterals, LVEF at rest was 52 +/- 7%, and LVEF during exercise was 41 +/- 9% (p less than 0.005 vs good collaterals).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

Pharyngeal myotomy for vocal rehabilitation postlaryngectomy.

In those patients requiring total laryngectomy, esophageal speech appears to be the most desirable form of rehabilitation. Satisfactory esophageal speech is only obtained in 40 to 65% of the patients. Tracheoesophageal shunts as per Singer and Panje have provided solutions for a significant number of non-speakers, but still present problems as well as failures. Efforts to correct these failures have led to the concept of constrictor and cricopharyngeal discoordination. Pharyngeal block has demonstrated not only temporary correction of tracheoesophageal shunt failure but improvement and production of esophageal speech in non-shunted patients. Subsequently myotomy has provided permanent esophageal speech. This paper proposes consideration of this procedure in esophageal speech failures, when the Taub test and/or pharyngeal block demonstrates the presence of constrictor-cricopharyngeus discoordination. Representative cases are presented.

Female↗
PubMed1984

Housing change of chronic schizophrenic patients: a consequence of the revolving door.

A study of 119 chronic schizophrenics discharged to the community revealed that by 1 year post release, 50% have changed their living arrangement at least once. Housing changes, which typically involved movement from one non-institutional living situation to another, followed rehospitalization episodes and appear to be a consequence of the revolving door phenomenon. By virtue of its impact on rehospitalization, interpersonal stress in the patient's living environment has an indirect effect on housing change. The remarkable frequency with which housing changes occur among the mentally ill in both sheltered care and non-institutional living settings deserves consideration in the planning of mental health and social welfare service for this constituency.

Chronic Disease↗