Search PubMed⌕ Search

Biomedical subjects

L Goldman

Publications and source records attributed to L Goldman.

At least 307 records · Page 17Linked to original sources
PubMed1987

Granulocytopenia complicating colchicine therapy for primary biliary cirrhosis.

A case is presented of a 76-yr-old woman with primary biliary cirrhosis and adult polycystic liver disease who developed bone marrow toxicity associated with chronic low-dose colchicine therapy. Two months after starting colchicine therapy (0.6 mg b.i.d. p.o.), the patient developed hematologic toxicity as evidenced by transient but profound granulocytopenia which promptly reversed 4 days after the drug was stopped. Bone marrow examination revealed moderate hypocellularity of all cell lines and striking dysplastic changes in the late myeloid and erythroid series. There was no apparent toxicity involving other organ systems. The patient fully recovered. This case is compared with previous descriptions of colchicine toxicity.

Aged↗
PubMed1987

Correlates of cardiac and sudden death after ambulatory monitoring in a community hospital. Importance of clinical characteristics, congestive heart failure and tachyarrhythmias.

To analyze the prognostic importance of arrhythmias on routine 24-hour ambulatory monitoring, we prospectively followed 755 consecutive patients undergoing monitoring at a community hospital in the context of usual medical care. Of the 755 patients, 114 (15%) had ventricular tachycardia on monitoring. At a mean follow-up of 38 months, multivariate survival analysis indicated that congestive heart failure was the strongest correlate of death from all causes (relative risk (RR) = 2.6), cardiac death (RR = 3.5), and the sudden cardiac death (RR = 5.6); ventricular tachycardia was significantly correlated with death from all causes and with cardiac death, but had only a borderline association with sudden cardiac death (RR = 1.9, p = 0.08). While ventricular tachycardia on ambulatory monitoring is of prognostic importance, congestive heart failure, as determined by routine clinical examination, was a more powerful prognostic correlate of deaths from all causes, death from cardiac causes, and sudden cardiac death.

Adolescent↗
PubMed1987

Noncardiac surgery in the patient with heart disease.

Optimal care of the patient with heart disease undergoing noncardiac surgery requires that the members of the surgical team, including anesthesiologist, internist-cardiologist, and surgeon, be familiar with the cardiovascular response to surgery, preoperative cardiac risk stratification, and the unique pathogenesis of cardiac complications that may occur in the perioperative period. Preoperative evaluation and computation of cardiac risk, anesthetic considerations, along with perioperative care of the patient with ischemic heart disease, valvular heart disease, congestive heart failure, arrhythmias and conduction disorders, and hypertension is discussed.

Heart Diseases↗
PubMed1987

A chest pain clinic to improve the follow-up of patients released from an urban university teaching hospital emergency department.

During a 12-month period, 1,045 of 1,554 patients (67%) over age 30 seen in an urban teaching hospital emergency department with acute chest pain were released based on the clinical judgment of the examining physician. Patients who were released were offered follow-up within 24 to 72 hours in a hospital-based chest pain clinic. Of these 1,045 patients, 772 (74%) returned or were contacted by phone, and 29 were directly admitted; 14 had unstable angina, and eight had new myocardial infarctions. Because of its positive impact on the quality of care at an acceptable cost, the Chest Pain Clinic, which was originally instituted as part of a research protocol, has now become part of the routine spectrum of care provided at the University of Cincinnati Medical Center.

Adult↗
PubMed1987

New developments with the heavy metal vapor lasers for the dermatologist.

In controlled studies the heavy metal vapor lasers are important for dermatologic surgery, for vascular lesions, and for skin malignancies, especially those malignancies which cannot be treated by conventional means. The flexibility of the fiberoptic system for transmitting the lasers lends itself to laser vascular surgery, cancers of the skin, and mucous membranes. The heavy metal vapor laser is one of the few laser systems for clinical practice which include two different systems, thereby increasing applications.

Copper↗
PubMed1987

Integrated school and community programs.

Collaboration and coordination among school nurses, health teachers, guidance counselors, food service directors, principals, administrators, parents, and community agencies have the potential to upgrade school health programs. Benefits derived from an integrated school and community program are documented. Three models that have effectively brought together schools and community agencies are described.

Child↗
PubMed1987

Circadian variation of transient myocardial ischemia in patients with coronary artery disease.

To examine whether a significant circadian variation of transient myocardial ischemia exists and to better understand the character of such variation, 32 patients with chronic stable symptoms of coronary artery disease underwent one or more days of ambulatory monitoring of ischemic ST segment changes during daily life. A total of 251 episodes of ischemic ST segment depression occurred in 24 (75%) of the 32 patients with a median duration of 5 min (range 1 to 253). A significant circadian increase in ischemic activity was found with 39% of episodes and 46% of total ischemic time occurring between 6 A.M. and 12 P.M. (p less than .05 and p = .02, respectively). In 21 patients with ST segment depression during the 6 hr after waking and the 6 hr before sleep, 68% of episodes occurred in the morning compared with 32% in the evening. There were no significant differences in heart rate at onset, heart rate at 1 min before onset, and activity score associated with ST segment depression. The proportion of minutes showing ST segment depression when the heart rate was above the lowest rate associated with ST segment depression was significantly greater in the morning compared with the evening (26% vs 15%; p = .03). Thus the early morning increase in ST segment depression does not appear to be explained by differences in extrinsic activity and/or stress measured by physical activity score and heart rate response. More importantly, this phenomenon is often ignored by the usual patterns of drug administration for angina.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Forecasting coronary heart disease incidence, mortality, and cost: the Coronary Heart Disease Policy Model.

A computer simulation model was developed to project the future mortality, morbidity, and cost of coronary heart disease (CHD) in the United States population. The model contains a demographic-epidemiologic (DE) submodel, which stimulates the distribution of coronary risk factors and the conditional incidence of CHD in a demographically evolving population; a "bridge" submodel, which determines the outcome of the initial CHD event; and a disease history (DH) submodel, which simulates subsequent events in persons with a previous CHD event. The user of the model may simulate the effects of interventions, either preventive (i.e., risk factor modification) or therapeutic, upon mortality, morbidity, and cost for up to a 30-year period. If there were no future changes in risk factors or the efficacy of therapies after 1980, baseline projections indicate that the aging of the population, and especially the maturation of the post-World War II baby-boom generation, would increase CHD prevalence and annual incidence, mortality, and costs by about 40-50 per cent by the year 2010. Unprecedented reductions in risk factors would be required to offset these demographic effects on the absolute incidence of CHD. The specific forecasts could be inaccurate, however, as a consequence of erroneous assumptions or misestimated baseline data, and the model awaits validation based on actual future data.

Adult↗
PubMed1987

Sensitivity of routine clinical criteria for diagnosing myocardial infarction within 24 hours of hospitalization.

Myocardial infarction was diagnosed in 431 (30%) of 1460 patients with acute chest pain who had serial enzyme testing after admission to intensive or intermediate care units at three teaching and three community hospitals. The diagnosis was made within 12 hours of admission in 331 (77%) patients and within 24 hours in 415 (96%). Of the 16 patients with myocardial infarction who did not have enzyme abnormalities within 24 hours, 9 (56%) had recurrent ischemic pain during this 24-hour period. Of 451 patients who had neither enzyme abnormalities nor recurrent ischemic pain in the first 24 hours, only 7 (2%) ultimately met diagnostic criteria for myocardial infarction. These findings were prospectively validated in an independent testing set of 275 patients with myocardial infarction, 271 (99%) of whom either met diagnostic criteria for myocardial infarction or had recurrent ischemic pain within 24 hours of admission. These data suggest that 24 hours is nearly always a sufficient period to exclude myocardial infarction in patients without recurrent chest pain.

Aged↗
PubMed1987

Evaluation of creatine kinase and creatine kinase-MB for diagnosing myocardial infarction. Clinical impact in the emergency room.

We prospectively studied the performance of emergency room strategies using a single sampling of total creatine kinase (CK) only and total CK with, if total CK levels were elevated, CK-MB levels in 639 patients with acute chest pain, including 386 patients who were admitted and 253 patients who were discharged. Acute myocardial infarction was diagnosed in 104 patients and excluded in 535. An elevated total CK level had a sensitivity of only 38% and specificity of only 80%, whereas a CK-MB level over 5% of an elevated total CK level had a sensitivity of only 34% and specificity of 88%. The sensitivities of both CK and CK-MB were higher in patients who arrived more than four hours after the onset of symptoms, and, in this population, the strategy using CK-MB performed significantly better than the strategy using total CK alone. Since a very positive CK-MB in a low-risk patient can greatly raise the probability of myocardial infarction, future strategies using CK-MB may have a role in selected subsets in determining which patients should not be sent home. However, the sensitivity of a single sampling of CK and CK-MB is too low for these assays to be used to exclude myocardial infarction in the emergency room or to be used as the rationale for deciding not to admit a patient.

Adult↗
PubMed1986

Long-term survival of more than 2,000 patients after coronary artery bypass grafting.

Among 2,004 patients who underwent their first coronary artery bypass graft operation between January 1970 and December 1980 without concomitant valve replacement or aneurysmectomy, life-table survival was 89% at 5 years and 80% at 8 years after surgery. In a multivariate Cox model analysis, the independent correlates of long-term survival were emergent operation with cardiogenic shock (multivariate mortality rate ratio [RR] = 14.0), use of a postoperative intraaortic balloon pump (RR = 3.9), ejection fraction less than 50% (RR = 2.4), preoperative history of congestive heart failure (RR = 2.2), cardiopulmonary bypass time (RR = 1.4 for each 30-minute increment), uncorrected mitral regurgitation (RR = 1.5 for each increment of angiographic gradation), left main coronary artery narrowing (RR = 1.7) and diabetes (RR = 1.6). After controlling for these factors, age, sex and the percentage of narrowings that were bypassed were not independent correlates of long-term survival.

Adult↗
PubMed1986

Cost and quality in the use of blood bank services for normal deliveries, cesarean sections, and hysterectomies.

To reduce costs, preserve blood supplies, and enhance the safety of blood use during emergencies, the Department of Obstetrics and Gynecology and the blood bank at a teaching hospital recommended replacing pre-delivery crossmatch on selected patients with typing and screening for all patients undergoing normal or cesarean section delivery. Using an automated data system, it was shown that 75% and 50% reductions in the ordering of crossmatching for these two groups of patients promptly resulted, endured over a one-year follow-up period, and also spread to include patients undergoing hysterectomy. However, the cost of the increased use of typing and screening outweighed the reduced cost of crossmatching: actual annual costs increased by $11 151. We conclude that test-ordering practices can be changed surprisingly easily if a specific and reasonable policy is advocated by influential clinicians. However, changes in test use can cause unexpected cost increases. Only detailed study of practice patterns can reveal cost consequences for a specific institution.

Blood Grouping and Crossmatching↗
PubMed1986

Application of photodynamic therapy in plastic surgery.

Photodynamic therapy is a technique for administering a sensitizer, hematoporphyrin derivative, which is selectively retained in malignant tissue. This is then activated by light, usually of 630 nm resulting in selective deterioration of the malignant tissue. This technique has been used for detecting and treating a variety of cancers in experimental animals and human beings. In plastic surgery, it has been applied to both basal and squamous cell carcinomas as well as to other skin lesions. Metastatic deposits will also respond to this treatment. Advantages include ease of treatment, sometimes requiring little or no anesthesia, low incidence of reactions, ability to repeat the treatment any number of times, and sparing of normal tissue. Photodynamic therapy has been used as a salvage operation, to clear tissue of suspected or probable remaining malignant disease, and to alleviate the need for a radical operation, allowing a more conservative one. Photodynamic therapy continues to be an investigational tool, and it should be used only as an adjunct to commonly accepted techniques, and then only when needed. Common disadvantages include a severe photosensitivity of the patient for several weeks following administration of the drug as well as inability to treat adequately bulky tumors. New techniques of administration and methods of activation will make this an increasingly common and useful tool in the practice of plastic surgery.

Aged↗