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Biomedical subjects

J Goldstein

Publications and source records attributed to J Goldstein.

At least 433 records · Page 24Linked to original sources
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Atriocaval mesothelioma in a male Sprague-Dawley rat.

The histological, immunohistochemical, and electron microscopic characteristics of a spontaneous case of atriocaval mesothelioma are described in a 102-wk-old male Sprague-Dawley rat. The immunohistochemical characteristics of the tumor are compared with those of a pericardial mesothelioma in a female Sprague-Dawley rat.

Animals↗
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Corticosteroid injections of the nasal turbinates: past experience and precautions.

Clinical experience with triamcinolone acetonide (Kenalog) injections into the nasal turbinates for allergic and vasomotor rhinitis is reported by two authors. Gratifying results have occurred in most of the over 60,000 patients treated, with no serious side effects. Two cases of intravascular injections of another corticosteroid reaching the retinal circulation are reported, and methods for preventing this complication are proposed.

Administration, Intranasal↗
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Evaluation of patient's knowledge of diabetes self-care.

A survey conducted at a Veterans Administration Hospital to evaluate patient capability for self-management found that over 35 per cent of the patients interviewed lacked any formal training. Seventeen patients had been placed on insulin without formal instruction. Almost one half the patients who claimed to have attended training programs could not demonstrate adequate knowledge or skills in any of the major areas of self-care: insulin administration, urine testing, diet, foot care, and management of hypoglycemia and hyperglycemia. While patients with training were more knowledgeable than patients without training, the difference was slight. The results indicate the need for systematic analysis of patient knowledge and the evaluation of training programs on a continuing basis.

Adult↗
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A comparison of distinct modes of tumor cell death in Hodgkin's disease using morphology and in situ DNA fragmentation.

The study examined the morphology and frequency of cell death occurring spontaneously in lymph nodes from patients with Hodgkin's disease. In addition to necrosis, which was infrequent and usually in patches, we document two cell types showing features of individual cell death: mummy cells end apoptotic cells. Mummy cells present no evidence of DNA fragmentation, but show electron microscopic features of "dark cells." Apoptotic Hodgkin-Reed-Sternberg cells are found frequently and are easier to demonstrate by in situ and labeling of fragmented DNA than by light microscopy only. In many cases phagocytosis of apoptotic cells is also documented. The significance of these findings to the limited number of Hodgkin-Reed-Sternberg cells in most cases of Hodgkin's disease is discussed.

Cell Death↗
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Health care applications of complexity science. Life at the edge of chaos.

The authors explore complexity science, a relatively new field of inquiry, which holds for both clinicians and health care leaders the real possibility of stimulating fresh insights and approaches to health and medical care-both its provision and its organization. Two case studies are presented to illustrate how complexity theory can provide health care leaders with a new perspective on how to address the myriad challenges they confront daily: (1) a patient with dissociative identity disorder; and (2) a physician task group charged to advise on hospital medical staff reorganization and governance. These case studies help clinicians and leaders of health care organizations understand how complexity: (1) may be relevant, even helpful, as they consider difficult challenges in both patient and organizational management; and (2) might emerge as a synthesizing force as they face the extraordinarily complicated task of jointly creating integrated health care systems. A resource section is provided for those who may wish to further pursue the topic.

Adult↗
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Merging, de-merging, and emerging at Deaconess Billings Clinic.

Complexity theory offers a powerful model for effective mergers of health care organizations that differs substantially from customary approaches. Exploring how Deaconess Billings Clinic in Montana evolved from two separate and very different cultures provides insight into how organizations can apply a complex adaptive system (CAS) model of mergers to create more truly integrated health care systems. DBC's merger illustrates the phenomenon of emergence in complex systems, whereby structures arise that are not a synthesis of the pre-existing cultures or the result of a new culture being imposed. Instead, the merger is understood as an ongoing, self-organizing process appropriately characterized by fits and starts, feelings of uncertainty, and other natural challenges of change and growth. By squarely surfacing the distinct cultures of the organizations through abundant interaction, relationship building, and information flow, differences can be creatively transformed, resulting in deep-seated change and the emergence of a genuine, shared health care system culture.

Ambulatory Care Facilities↗
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The ACL-deficient knee: natural history and treatment options.

Injury to the anterior cruciate ligament removes the major stabilizing structure to anterior tibial translation. The initial trauma may lead to meniscal and cartilage damage, predisposing the knee to early degenerative changes. Moreover, a knee with an isolated ACL rupture may have recurrent episodes of instability that can lead to a similar degenerative course. At this time, one cannot accurately predict which patients will tolerate ACL deficiency, and which patients will not. Current long-term studies support a progressive worsening condition in the ACL and meniscal deficient knees. Physical therapy together with lifestyle modifications may be necessary. Those unwilling to make these types of changes or those with associated injuries may benefit from ACL reconstruction.

Anterior Cruciate Ligament↗
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The right gastroepiploic artery: an alternative conduit for myocardial revascularization.

The initial experience in 18 patients undergoing coronary artery bypass surgery with the right gastroepiploic artery (RGEA) between April 1988 and August 1989 is reported. The indication for RGEA-use included the aim to obtain complete arterial revascularization in 15 patients and absence of suitable veins in 3 patients. Twelve patients had at least one previous CABG-operation. The average number of distal arterial anastomoses per patient was 2.5. The RGEA was connected to the right coronary artery (RCA) or its terminal branches in 13 patients, to the circumflex (CX) in 2 and sequentially to RCA and CX in 3 patients. In combination to the RGEA, 8 patients received bilateral internal mammary grafts and 6 patients received a single IMA-graft. There was one hospital death and there were no major early or late complications related to the RGEA-use. Postoperative angiographic controls in 16 patients revealed only one early RGEA-graft occlusion due to inadequate diameter and low run-off. There was one demonstrated late occlusion. These early results suggest that the RGEA can be used as an in situ graft to the posterior coronary vessels. Indications can be extended in function of the longterm patency and functional results.

Adult↗
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Consumers' awareness of barrier protection in dentistry.

Because of the scarcity of printed educational material available to the oral healthcare consumer regarding barrier protection in the dental office, four students at the Fones School of Dental Hygiene conducted a senior project that hypothesized that dental health consumers are poorly informed about barrier protection. Data received from a questionnaire were analyzed to determine the participants' awareness of barrier protection in the dental care setting; specifically, the use of masks, gloves, and protective eyewear. Of the 400 participants, 72% reported that their dentist wore gloves. Of the 321 participants who indicated that their dentist employs a dental hygienist, 76% reported that the dental hygienist wears gloves. And of the 334 participants who indicated that their dentist employs a dental assistant, 65% reported that their dental assistant wears gloves. The percentage of participants who reported the use of protective eyewear and masks is lower. Survey participants who visited offices where dental hygienists and dental assistants are employed were more likely to notice the dentist wearing a mask, gloves, and protective eyewear. Eighty-nine percent of the participants replied that they knew why masks, gloves, and protective eyewear should be worn in the dental setting; 40% replied that they would like more information.

Communicable Disease Control↗
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Desperately seeking science: the creation of knowledge in family practice.

Most medical consultations are for self-limiting conditions. While technical expertise remains necessary, creating therapeutic knowledge in this context is the joint responsibility of physician and patient, and depends upon recognition that the observer, the observation, and the observed form a temporary union.

Communication↗
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Immunoblastic lymphadenopathy with pulmonary lesions and positive sputum cytology.

A case of immunoblastic lymphadenopathy is presented. The patient's diagnosis was made from his clinical findings and lymph node pathology. Of particular note are long-standing pulmonary lesions of undetermined etiology and the exfoliation in sputum specimens of large numbers of immunoblasts identical to those seen in histologic sections of lymph node. Although other cases of immunoblastic lymphadenopathy with pulmonary findings have been published, 4, 5 only the histomorphology of these lesions has been described. This is the first reported case of immunoblastic lymphadenopathy with positive pulmonary cytology. Diagnosis of this condition requires histopathologic evaluation of diagnostic lymph nodes. Immunoblasts may be identified cytologically in sputum preparations and in this context are suggestive of but not diagnostic of this entity. The use of methyl green-pyronine stain to better differentiate immunoblasts is recommended.

Humans↗
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Haemodynamic, gasometric and haematological effects of air infusion in dogs: leukotriene inhibition with U-60,257.

Air embolization has been shown to produce a reversible permeability-type of pulmonary oedema. The present study investigated the haemodynamic, gasometric and haematological changes associated with air infusion in the spontaneously breathing dog (weight 31 +/- 5 kg). Air was infused at a rate of 10 ml X min-1 for 60 min (10 dogs) or 180 min (5 dogs). During the air infusion, a dramatic increase in pulmonary artery pressure was associated with only a moderate increase in right atrial pressure and limited decreases in arterial pressure and in cardiac output. A marked decrease in end-tidal PCO2 reflected the increase in dead space. These changes were stable during air infusion, but rapidly reversed after the end of infusion. However, hypoxaemia, defined by a decreased PaO2/PAO2 ratio, deteriorated with time and was only partially reversible. At histological examination, interstitial pulmonary oedema was present around the pulmonary arterioles. Air infusion was associated with rapid decreases in circulating leukocytes and platelets and complement activation. Since leukotriene release might be associated with leukocyte activation in this model, seven additional dogs were pretreated by inhalation of 10 mg of the leukotriene inhibitor U-60,257. The increase in pulmonary vascular resistance and in pulmonary shunt were moderately reduced and the drop in circulating leukocytes and platelets was strikingly abolished in the treated animals. Air infusion in the spontaneously breathing dog represents a model of very stable and reversible pulmonary hypertension. It can reproduce important pathophysiological features implicated in the development of pulmonary oedema.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗