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Biomedical subjects

L R Goodman

Publications and source records attributed to L R Goodman.

At least 19 recordsLinked to original sources
PubMed2003

Exercise-induced endocrine pathologies.

There has been a substantial increase in women practicing sports over the past 30 yr. While exercise provides many health benefits, there appears to be a unique set of risks associated with intense exercise for the female athlete. The female athlete triad encompasses these risks, including amenorrhea, osteoporosis and eating disorders. The incidence of menstrual irregularities including primary and secondary amenorrhea and shortened luteal phases is much higher among women partaking in athletics, specifically in sports requiring low body weight for performance and aesthetics. The hormone pattern seen in these amenorrheic athletes includes a decrease in GnRH pulses from the hypothalamus, which results in decreased pulsatile secretion of LH and FSH and shuts down stimulation of the ovary. The recently discovered hormone leptin may also play a large role as a significant mediator of reproductive function. The prevalence of eating disorders is high among female athletes who practice sports which emphasize leanness. Consequently, the cause of menstrual irregularities is not due to the exercise alone, but to chronic inadequate or restrictive caloric intake that does not compensate for the energy expenditure. The most dangerous risk associated with amenorrhea for the female athlete is the impact on the skeleton. Complications associated with amenorrhea include compromised bone density, failure to attain peak bone mass in adolescence and increased risk of stress fractures. The diagnosis of exercise-associated menstrual dysfunctions is one of exclusion. The most effective treatment is to decrease the intensity of the exercise and increase the nutritional intake. Hormone replacement has also been under investigation as a possible treatment.

Adolescent↗
PubMed2002

Toxicological studies in tropical ecosystems: an ecotoxicological risk assessment of pesticide runoff in South Florida estuarine ecosystems.

A multiyear study in the C-111 canal system and associated sites in Florida Bay was undertaken to determine the potential pesticide risk that exists in South Florida. After the examination of extensive pesticide concentration data in surface water, tissues, and semipermeable membrane devices (SPMDs), canal contamination seems to be derived from the extensive agricultural production that drains into the C-111 canal. The results of this study indicate that runoff from agricultural processes led to quantifiable pesticide residues in both canal and bay surface water, which occasionally exceeded current water quality criteria. The major pesticide of concern was endosulfan, which was detected at 100% of the sites sampled. Endosulfan exposure did not cause any acute effects in fish and crustaceans deployed in field bioassays. Chronic effects were observed in copepods, clams, and oysters but could not be attributed to endosulfan exposure. The decision to alter the C-111 canal flow and allow increased freshwater flow into the adjacent Everglades National Park may result in discharges of pesticides into the Everglades. Continued monitoring in this area is needed during this change in flow regime.

Agriculture↗
PubMed2001

Venous thromboembolic disease: CT evaluation.

Helical and multidetector CT has proven to be a valuable imaging modality for both pulmonary embolism and deep venous thrombosis. This paper will review the sensitivity and specificity of CT and discuss diagnostic algorithms utilizing CT and more established imaging technologies.

Algorithms↗
PubMed2000

Subsequent pulmonary embolism: risk after a negative helical CT pulmonary angiogram--prospective comparison with scintigraphy.

PURPOSE: To determine whether a helical computed tomographic (CT) scan that is negative for pulmonary embolism (PE) is a sufficiently reliable criterion to safely withhold anticoagulation therapy. MATERIALS AND METHODS: Patients with negative helical CT scans were prospectively compared with patients with negative or low-probability scintigrams. In a 460-bed university hospital and clinic, 1,015 adult patients underwent either scintigraphy or helical CT for possible PE for 25 months. Five hundred forty-eight patients who had negative images and were not receiving anticoagulation therapy were prospectively followed up for 3 months for clinical, new imaging, death certificate, or autopsy evidence of subsequent PE. Ninety-seven patients were lost to follow-up. RESULTS: Subsequent PE was found in two (1.0%) of 198 patients with negative CT scans, none of 188 patients with negative ventilation-perfusion (V-P) scans, and five (3.1%) of 162 patients with low-probability V-P scans (not statistically significant). Patients in the helical CT group were hospitalized more often, had more severe disease, had more substantial PE risk factors, and had a higher death rate. No deaths were attributed to PE in either group. CONCLUSION: The frequency of clinical diagnoses of PE after a negative CT scan was low and similar to that after a negative or low-probability V-P scan. Helical CT is a reliable imaging tool for excluding clinically important PE.

Adult↗
PubMed1999

Spiral computed tomography in the evaluation of pulmonary embolism.

Determining the presence or absence of thromboembolic disease can often be problematic. Traditional diagnostic algorithms are reviewed and discussed. Spiral CT technology allows a relatively noninvasive visualization of the pulmonary vasculature and is a promising new diagnostic modality for acute and chronic thromboembolic disease. Its potential roles are discussed, and a new diagnostic algorithm is proposed.

Acute Disease↗
PubMed1999

Adult respiratory distress syndrome due to pulmonary and extrapulmonary causes: CT, clinical, and functional correlations.

PURPOSE: To assess the differences in CT appearance between adult respiratory distress syndrome due to pulmonary disease (ARDSP) and that due to extrapulmonary disease (ARDSEXP) and determine whether the variable appearances of ARDS are due, in part, to the initial pulmonary and systemic causes. MATERIALS AND METHODS: Thirty-three patients, 22 with ARDSP and 11 with ARDSEXP, underwent helical CT shortly after intubation. Two readers evaluated images for the type, extent, and distribution of pulmonary opacities; secondary findings; and correlation with survival and physiologic parameters. RESULTS: In both ARDSP and ARDSEXP, approximately 80% of the lung was abnormal. In ARDSP, ground-glass opacification and consolidation were equally prevalent, whereas in ARDSEXP ground-glass opacification was dominant. Ground-glass opacification was evenly distributed, whereas consolidation tended to be dorsal and caudal. ARDSP often caused asymmetric consolidation, whereas ARDSEXP caused symmetric ground-glass opacification. Air bronchograms were almost universal. Pleural effusions were present in one-half of the patients, and Kerley B lines and pneumatoceles were uncommon. Lung consolidation correlated with the ratio of mean partial pressure of arterial oxygen to fraction of inspired oxygen, shunt fraction, and pulmonary arterial pressure. The patients who died tended to have more consolidation and asymmetric disease. CONCLUSION: ARDSP tends to be asymmetric, with a mix of consolidation and ground-glass opacification, whereas ARDSEXP has predominantly symmetric ground-glass opacification. In both groups, pleural effusions and air bronchograms are common, and Kerley B lines and pneumatoceles are uncommon.

Adult↗
PubMed1998

Utility of CT scan evaluation for predicting pulmonary hypertension in patients with parenchymal lung disease. Medical College of Wisconsin Lung Transplant Group.

OBJECTIVE: To determine the utility of CT-determined main pulmonary artery diameter (MPAD) for predicting pulmonary hypertension (PH) in patients with parenchymal lung disease. DESIGN: Retrospective review of right-heart hemodynamic data and chest CT scans in 45 patients. SETTING: Tertiary-referral teaching hospital and VA hospital. PATIENTS: Between October 1990 and December 1995, 36 patients referred for evaluation of parenchymal lung disease or possible pulmonary vascular disease were found to have PH, as defined by mean pulmonary artery pressure (mPAP) > or =20 mm Hg. Nine control patients (mPAP <20 mm Hg) were also identified (4 from hospital records search, 5 after evaluation for possible PH). RESULTS: CT-determined MPAD was 35+/-6 mm in patients with PH and 27+/-2 mm in control subjects. In our group of patients, MPAD > or =29 mm had a sensitivity of 87%, specificity of 89%, positive predictive value (PPV) of 0.97, and positive likelihood ratio (LR) of 7.91 for predicting PH; in the subgroup of patients with parenchymal lung disease (n=28, PH and control subjects), MPAD > or =29 mm had a sensitivity of 84%, specificity of 75%, PPV of 0.95, and positive LR of 3.36 for predicting PH. The most specific findings for the presence of PH were both MPAD > or =29 mm and segmental artery-to-bronchus ratio > 1:1 in three or four lobes (specificity, 100%). There was no linear correlation between the degree of PH and MPAD (r=0.124). CONCLUSIONS: CT-determined MPAD has excellent diagnostic value for detection of PH in patients with advanced lung disease. Therefore, standard chest CT scans can be used to screen for PH as a cause of exertional limitation in patients with parenchymal lung disease. Because CT is commonly used to evaluate parenchymal lung disease, this information is readily available.

Adult↗
PubMed1997

Fast gradient echo magnetic resonance imaging of the normal diaphragm.

To determine the ability of fast gradient-recalled echo (GRE), breath-hold magnetic resonance imaging (MRI) to depict all regions of the diaphragm, 13 volunteers were scanned in coronal and sagittal planes. The central to anterior left hemidiaphragm and the posterior lumbar portions were each demonstrated in 12 subjects (92%). The crura were visible crossing anterior to the aorta in the sagittal plane in eight subjects (62%) and in the coronal plane in six subjects (46%). In the sagittal plane, the right crus was evident in eight subjects (62%). Muscular portions of the diaphragm in contact with the liver or body wall were less frequently discernible, and the central tendon could not be confidently resolved. Several artifacts occurred that interfered with visualization of the diaphragm. These observations indicate that many regions of the diaphragm can be seen with fast GRE, breath-hold MRI, but there are some limitations in depicting the diaphragm in its entirety.

Adult↗
PubMed1996

Blastomycosis.

Blastomycosis is a relatively uncommon disease, even in its endemic region. The clinical course and symptoms are highly variable; patients may be asymptomatic or present with severe, fulminant disease. Antifungal agents are effective against pulmonary and disseminated disease, but relapses and reactivation can occur. The radiographic findings are nonspecific, and patients are often assumed to have bacterial pneumonia, malignancy, tuberculosis, or sarcoidosis before the correct diagnosis is made.

Adult↗
PubMed1996

An acute/critical care nurse practitioner program.

To meet the demands for quality care, nursing education and nursing practice must collaborate and integrate services to educate Advanced Practice Nurses (APNs). One teaching hospital's successful APN curriculum is described. Topics addressed include structural reengineering, continuous quality improvement (CQI) and curriculum redesign.

Acute Disease↗