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Biomedical subjects

L Goldman

Publications and source records attributed to L Goldman.

At least 415 records · Page 23Linked to original sources
PubMed1980

Patient-physician concordance in problem identification in the primary care setting.

We analyzed how often patients and physicians identified the same principal problem for 439 return primary care visits. Agreement between the patient and physician, called concordance, was scored as complete when both cited a problem in the same organ-system (208 visits; 47%); as partial when the patient cited a problem that was anywhere but first on the physician's problem list but both parties agreed on the biological or psychosocial nature of the principal problem (114 visits; 26%); or as absent (117 visits; 27%). Concordance scores were significantly lower when physicians identified a principal psychosocial problem or when patients identified a principal problem related to psychosocial issues, preventive medicine, the musculoskeletal system, or accidents. Because physicians in the Primary Care Internal Medicine Training Program were significantly more likely to identify principal psychosocial problems, their concordance scores were significantly lower than those of standard internal medicine track physicians.

Attitude to Health↗
PubMed1980

Evaluation of chemotherapeutic responsiveness in Nb rat prostate cancer model. 5-fluorouracil, methotrexate, cyclophosphamide, and adriamycin.

We elevated four chemotherapeutic agents in 105 male Nb rats with transplanted Nb rat prostatic tumors. Tumor volume and the presence or absence of metastasis were determined at the completion of the experiment and served as indicators of agent effectiveness. 5-Fluorouracil and cyclophosphamide were the most effective agents (P < 0.01). Seven of ten animals treated with cyclophosphamide had complete tumor regression; only one had pulmonary visceral or mediastinal metastasis. In other chemotherapeutic and control groups, no animal had complete tumor regression and approximately 50% of the experimental animals developed metastases despite chemotherapy. Final tumor volume was significantly reduced when compared to controls in the high-dose methotrexate doxorubicin hydrochloride (Adriamycin), cyclophosphamide, and both 5-fluorouracil groups (P < 0.01).

Animals↗
PubMed1979

Serial assessment of doxorubicin cardiotoxicity with quantitative radionuclide angiocardiography.

We measured cardiac performance sequentially, using quantitative radionuclide angiocardiography to estimate left ventricular ejection fraction in 55 patients receiving doxorubicin for treatment of cancer. With final doxorubicin dosages greater than 350 mg per square meter, the lowest ejection fraction measured was significantly less than the initial determination. Five patients had severe cardiotoxicity (congestive heart failure). All had an ejection fraction of less than 30 per cent at the time of heart failure, and demonstrated moderate cardiotoxicity (a decline in ejection fraction by at least 15 per cent to a final value of less than 45 per cent) before clinical manifestations. Six patients with moderate toxicity in whom doxorubicin was discontinued did not have heart failure or a further decline in ejection fraction during the follow-up period. Moderate toxicity was continued, but mild toxicity (decline of ejection fraction by greater than 10 per cent, noted in 11 patients) was not well predicted. The assessment of radionuclide left ventricular ejection fraction during doxorubicin therapy may make it possible to avoid congestive heart failure.

Adult↗
PubMed1979

Multiple gated cardiac blood pool imaging for left ventricular ejection fraction: validation of the technique and assessment of variability.

The intrinsic variability and accuracy of left ventricular ejection fraction determined by multiple gated cardiac blood pool imaging was evaluated in 83 patients. Ejection fraction by gated studies correlated well with data from first pass radionuclide angiocardiography (r = 0.94) and from contrast angiography (r = 0.84). Intra- and interobserver variabilities of absolute ejection fraction were minimal (mean +/- standard deviation 1.4 +/- 1.2 and 1.6 +/- 1.5 percent, respectively) and were not different for normal (ejection fraction 55 percent or greater) and abnormal patients. Ejection fraction was determined twice in 70 patients: on the same day at intervals separated by 1 to 2 hours (41 patients) and on 2 different days (29 patients). Ejection fraction ranged from 18 to 91 percent and was normal in 37 patients. There was no difference in mean serial variabilities of absolute ejection fraction for all repeat studies performed on the same and separate days (3.3 +/- 3.1 versus 4.3 +/- 3.1 percent (not significantly different). The mean variability of absolute ejection fraction for repeat studies in normal patients was significantly greater than in abnormal patients (5.4 +/- 4.4 versus 2.1 +/- 2.0 percent, P less than 0.01). The incidence rate of absolute interstudy changes of 5 percent or more was significantly higher in normal than in abnormal patients (P less than 0.01). This differential variability should be considered in interpreting sequential changes in left ventricular ejection fraction. To be attributed to nonrandom physiologic alterations, the absolute change in ejection fraction should be 10 percent or more in normal patients and 5 percent or more in abnormal patients.

Angiocardiography↗
PubMed1979

Internally perfused Myxicola giant axons showing long-term survival.

An improved method for internally perfusing the Myxicola giant axon based on removing the axoplasm by dispersing it in KCl-KF salt solutions is described. Proteolytic enzymes are not introduced. With this improved method perfused preparations show long-term stability of their electrical properties and the ability to generate action potentials for many hours. Mean initial values for resting membrane potential, action potential amplitude, and peak inward current were -68 mV, 118 mV, and 3.62 mA/cm2, respectively. Mean resting membrane resistance was 75% of that in intact axons. In one series of voltage clamp experiments, perfused preparations remained excitable for a mean period of 5 1/2 h, but this period could exceed 10 h. 4 min are needed for exchange of internal solutions. At least 50 mM KF is required both in the axoplasm liquefying solution and in the standard perfusate to obtain stable preparations.

Action Potentials↗
PubMed1979

Surgery by laser for malignant melanoma.

Lasers have been used for photocoagulation and photoexcision of malignant melanomas when conventional instruments could not be used. Lasers are useful for destruction of cutaneous metastases from malignant melanomas especially when numerous and dispersed. The color of melanomas makes for selective absorption of energy from lasers in the visible light range. Surgery by lasers is still an investigative form of surgery with current research studies on immediate placement of grafts, lymphatic migration of malignant cells after laser surgery, and relevant immunologic studies.

Humans↗
PubMed1979

Anticoagulants and myocardial infarction. The problems of pooling, drowning, and floating.

The time and expense required for adequate-sized, randomized control trials may often tempt investigators to try to answer long-standing clinical questions by retrospective analysis of data combined from old studies. In a recent example of such "pooling," the authors concluded not only that anticoagulation is beneficial in acute myocardial infarction but also that further experimental trials would be unethical. This conclusion can be disputed because of scientific, statistical, and clinical standards that were not fulfilled in the "pooled" analysis. Scientifically, the pooling of data from different sources can be valid only if the component studies contain patients who are sufficiently similar in diagnosis, clinical severity, principal treatment, and outcome events. Mathematically, exact numbers rather than percentages should be pooled. Clinically, even when the pooling process is appropriate, recent changes in ancillary therapy may negate the applicability of the old data to current medical practice.

Anticoagulants↗