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Biomedical subjects

M A Goodman

Publications and source records attributed to M A Goodman.

At least 37 records · Page 2Linked to original sources
PubMed1992

Plasma levels of the lipid mediators, leukotriene B4 and lyso platelet-activating factor, in intraoperative salvaged blood.

It has been shown that white cells and platelets release their granules into the plasma of salvaged blood. Whether this release is due to destruction alone or a combination of destruction and activation is not known. Lipid mediators, platelet-activating factor and leukotriene B4, are produced by activated white cells and platelets and have effects on the cardiovascular, respiratory and immune systems and the microcirculation. The aim was to determine if white cells and platelets are activated in salvaged blood by measuring the levels of these lipid mediators. Ten patients undergoing aortic surgery, where intraoperative salvage was used, were studied. Blood samples were taken from the patient's circulation and the salvaged blood before and after washing. The levels of leukotriene (LTB4) and lyso platelet-activating factor (PAF, the stable degradation product of PAF) were measured in the samples by a radioimmunoassay and a bioassay, respectively. The levels of both these substances increased in the unwashed salvaged blood (mean patient levels: LTB4 27 +/- 4.3 ng/ml and L-PAF 73 +/- 8.5 ng/ml; mean unwashed blood levels: LTB4 95 +/- 12.2 ng/ml and L-PAF 172.9 +/- 26.4 ng/ml) and were reduced by washing of the collected blood (mean washed blood levels of LTB4, 23.9 +/- 4.8 ng/ml, and L-PAF 18 +/- 5 ng/ml). The increase of the lipid mediators in the unwashed salvaged blood indicates that white cells and platelets are activated and releasing lipid mediators. Washing of the collected blood is effective in removing the lipid mediators.

Blood Platelets↗
PubMed1991

Lipolytic enzyme and phospholipid level changes in intraoperative salvaged blood.

Autotransfusion is becoming increasingly popular, mainly because it eliminates the risk of disease transmission. One of the techniques available is intra-operative blood salvage and retransfusion with or without washing of the collected blood. The blood collected during this process is subjected to a variety of chemical and physical insults which can alter the normal composition of the plasma by activating plasma and cellular homeostatic mechanisms. In this study, we measured the plasma levels of total phospholipids, lysolecithin and non-esterified fatty acids, and the lipolytic enzymes phospholipase A2 (PLA2) and lipase in the salvaged blood before and after washing. In the unwashed salvaged blood the mean levels of PLA2, non-esterified fatty acids and lysophospholipids increased by 144, 96 and 149%, respectively, while those of total phospholipids and lipase did not change to any extent. All these substances were reduced to well below the patients circulating plasma levels by washing the collected blood. The changes indicate that the lipid profile of salvaged blood is significantly altered and that potentially dangerous substances such as PLA2 and its metabolites, lysolecithin and non-esterified fatty acids, are present in increased amounts. Washing the blood is recommended prior to reinfusion.

Blood Loss, Surgical↗
PubMed1991

Levels of complement factor C3 and its activated product, C3a, in operatively salvaged blood.

In intra-operative blood salvage the collected blood is exposed to traumatized tissue and a synthetic circuit. Because of this exposure it was expected that the complement system, which is a contact system present in plasma, would be activated in salvaged blood. To determine whether this occurs, the plasma levels of the complement factor C3 and its activated fragment, C3a, were measured in intra-operative salvaged blood before and after washing. Samples were obtained from patients undergoing aortic surgery where intra-operative salvage was used. In the unwashed salvaged blood, the level of C3 fell (mean C3: 0.33 g/L) and the level of C3a increased (mean C3a: 1994 ng/mL) compared with the patient circulating levels of C3 and C3a (mean C3: 0.70 g/L, mean C3a: 855 ng/mL) respectively. Washing of the collected blood reduced the C3a level (mean: 346 ng/mL) to the patient's level and reduced C3 to the lower detection limit of the test (less than 0.2 g/L). The raised level of C3a and the reduced level of C3 confirm that the complement system is activated and imply that other complement factors are also activated.

Blood Loss, Surgical↗
PubMed1991

Synchronous combined oesophagectomy: a review of 20 cases.

Twenty patients with carcinoma of the oesophagus treated by a modification of the Ivor Lewis oesophagectomy using two surgeons working synchronously were reviewed. All the patients had carcinomas of the middle or lower thirds of the oesophagus. The median age was 68 years. There were 17 males and 3 females. Average total operating time was 3 h 40 min. There was one peri-operative death. The median length of stay was 15 days. The synchronous combined approach to oesophagectomy has advantages, which are discussed, similar to synchronous combined abdomino-perineal resection of the rectum.

Adenocarcinoma↗
PubMed1990

Entrapment of popliteal artery and vein.

Entrapment of the popliteal vessels is reported to be rare. Lack of knowledge of this entity may result in a low reported incidence. To help wider appreciation and early recognition of this condition, we report five cases of popliteal vessel entrapment and discuss the associated features.

Adolescent↗
PubMed1990

Elastase levels in salvaged blood and the effect of cell washing.

Blood was salvaged from the operating field of 16 orthopaedic and vascular operations and processed by the Shiley Dideco cell saver for retransfusion. Plasma elastase levels in the salvaged blood were used as a marker of white cell lysosomal granule release. The plasma level of this enzyme was measured by the technique described by Dreher et al. using the immuno-activation (IMAC) system (Merck-Darmstadt, Federal Republic of Germany). The levels of the enzyme rose dramatically in the salvaged blood and were reduced to preoperative levels after washing in the cell saver. Washing of the salvaged blood before retransfusion is effective in reducing the plasma levels of white cell lysosomal contents which have the potential for producing harmful systemic effects.

Blood Transfusion, Autologous↗
PubMed1989

Transfer of a beta-turn structure to a new protein context.

Four-residue beta-turns and larger loop structures represent a significant fraction of globular protein surfaces and play an important role in determining the conformation and specificity of enzyme active sites and antibody-combining sites. Turns are an attractive starting point to develop protein design methods, as they involve a small number of consecutive residues, adopt a limited number of defined conformations and are minimally constrained by packing interactions with the remainder of the protein. The ability to substitute one beta-turn geometry for another will extend protein engineering beyond the redecoration of fixed backbone conformations to include local restructuring and the repositioning of surface side chains. To determine the feasibility and to examine the effect of such a structural modification on the fold and thermodynamic stability of a globular protein, we have substituted a five-residue turn sequence from concanavalin A for a type I' beta-turn in staphylococcal nuclease. The resulting hybrid protein is folded and has full nuclease enzymatic activity but reduced thermodynamic stability. The crystal structure of the hybrid protein reveals that the guest turn sequence retains the conformation of the parent concanavalin A structure when substituted in the nuclease host.

Binding Sites↗
PubMed1989

Neuroleptic malignant syndrome in the multiple trauma patient.

A 25-year-old multiply traumatized patient developed neuroleptic malignant syndrome (NMS) secondary to the use of Haldol. The diagnosis was delayed due to poor recognition of the syndrome, risking a fatal outcome. The signs and symptoms of the syndrome are presented along with the pathophysiology and the available treatments for NMS.

Adult↗
PubMed1989

Chronic osteomyelitis of the clavicle.

Osteomyelitis of the clavicle is an uncommon disease, but it should be considered in patients who present with pain, cellulitis, or drainage in the sternoclavicular area following head and neck surgery, irradiation, subclavian vein catheterization, or immunosuppression. An idiopathic presentation is possible. In contrast to primary osteomyelitis of the clavicle, which is occasionally seen in children, secondary osteomyelitis is quite rare. It is often mistaken for a fracture or a possible neoplasm on plain x-rays. Tomograms and CT scanning are confirmatory, and in early cases, technetium-99m bone scanning can be helpful. Treatment must include early, aggressive surgical debridement of all affected tissues, followed by wound coverage with a well-vascularized flap and perioperative antibiotics.

Abscess↗
PubMed1987

Metastatic cancer in Paget's disease of bone. A case report.

A 50-year-old white male presented with concurrent Paget's disease of bone and metastatic adenocarcinoma. Our review of the literature and our clinical experience suggests that carcinoma coexisting at the site of bone involved with Paget's disease occurs more commonly than has been recognized. The paucity of reports of tumor metastatic to sites of Paget's disease of bone may be due to an artifact of data collection. The differentiation of metastatic from de novo tumors must be accomplished by biopsy, and the diagnosis is essential for appropriate treatment. Commonly a correlation of known tumor types with Paget's disease is made, and metastatic tumors are excluded.

Adenocarcinoma↗
PubMed1987

Limb sparing operations for sarcomas of the extremities involving critical arterial circulation.

Seven patients underwent resection of a sarcoma of the extremity requiring excision of a vital artery and revascularization. These included osteosarcoma of the pubis, osteosarcoma of the distal femur, undifferentiated sarcoma of the thigh, liposarcoma of the thigh, liposarcoma of the popliteal space, chondrosarcoma of the proximal tibia and rhabdomyosarcoma of the thumb. Preoperative evaluation included computed tomographic scan, magnetic resonance imaging and angiography. Operation involved excision of the iliac artery in one instance, femoral artery in three, popliteal artery in two instances and radial artery in one. Wide local resection including revascularization was undertaken when the tumor could be resected with the artery but separated from the nerve and it was a low grade malignant disease or the patient refused amputation for a high grade malignant disease. In five patients, the tumor margins were adequate. One patient with an osteosarcoma of the pubis with distant disease had a palliative resection and one patient had positive margins but refused amputation. Coverage of the soft tissue and vascular grafts was achieved using a distant pedicle flap in two patients. Amputation was avoided and each patient remained ambulatory. Five patients remained free of disease with patent grafts at six months to six years of follow-up study. One patient died of late myocardial infarction and one who underwent palliative resection died eight months later of metastatic disease. Involvement of the major arterial circulation does not preclude adequate resection of sarcomas of the extremity with limb salvage.

Adult↗
PubMed1986

Plasma cell tumors.

Multiple myeloma and solitary plasmacytoma are common reticuloendothelial diseases. They involve primarily the bone marrow but have occasional extramedullary components. Numerous complications have been reported with these diseases. Despite modern modes of therapy, the prognosis remains grim. Myeloma and plasmacytoma are part of the continuum of B-Cell lymphoproliferative disorders. Patients are generally between 50 and 70 years old and usually present because of pain. The diagnosis is established by laboratory methods, routine skeletal survey findings, and bone marrow or lesion biopsy. Treatment is primarily medical, with radiation therapy and surgery being used for local control of specific lesions as well as for the treatment of complications or associated lesions. Although the prognosis remains poor, the ability to treat the painful and disabling components of the disease has improved. The surgeon, although unable to cure, can aid the myeloma patient by providing the opportunity for a more productive, pain-free survival.

Adult↗
PubMed1985

Avascular necrosis of bone following combination chemotherapy for acute lymphocytic leukemia.

Avascular necrosis of bone (AVNB) is a known complication of systemic adrenocorticosteroid therapy, and one which is thought to be dose-related. However, despite the large amounts of prednisone which have been used in the standard treatment of acute lymphocytic leukemia (ALL), AVNB rarely has been reported in children with that disease. We described our experience with one adolescent with ALL who developed multifocal AVNB presenting as bone pain after aggressive chemotherapy that included a high cumulative dose of corticosteroids as well as other antitumor agents, some of which also have been associated with AVNB. Four similar cases from the literature are reviewed. Because the bone pain of AVNB can mimic that of leukemic relapse, this is an important entity to be aware of, and one which may become more common with increasingly aggressive combination chemotherapy.

Adolescent↗
PubMed1978

Metabolic and endocrine alterations in osteosarcoma patients.

Eighteen patients with primary osteosarcoma were studied for abnormal endocrinologic functions. Oral glucose tolerance tests revealed abnormal glucose, insulin, or growth hormone response curves in 78% of the study population. Elevated somatomedin values were noted in 72% of the patients tested. No significant deviations were observed in serum cortisol, estradiol, testosterone, follicle stimulating hormone, and luteinizing hormone levels. Likewise, lipid screening and 24 hour 17-hydroxy and 17-keto steroid excretion levels were normal. Statistically these derangements were unrelated, leading to the hypothesis that some additional factor or factors are present and responsible for the abnormalities noted. These deviations, found in association with primary osteosarcoma, constitute a new "paraneoplastic syndrome."

17-Ketosteroids↗
PubMed1978

Pre-infarction angina secondary to calcific aortic stenosis with Bernheim's effect.

Pre-infarction angina, in the absence of coronary artery disease, was found in a 62 year-old man with severe calcific aortic stenosis. After application of intraaortic balloon pump counter-pulsation, the condition was stabilized, and coronary arteriograms were safely carried out. Interestingly, an elevated right atrial and right ventricular end-diastolic pressure with an associated Bernheim's effect was demonstrated by cardiac catheterization. The hemodynamics of the right heart returned to normal after surgical correction of the aortic stenosis. The clinical indications for intra-aortic balloon pump counterpulsation in this setting are discussed.

Angina Pectoris↗