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Biomedical subjects

M Goldstein

Publications and source records attributed to M Goldstein.

943 records · Page 53Linked to original sources
PubMedDate not supplied

Nonbacterial pyospermia: a consequence of clomiphene citrate therapy.

OBJECTIVE: Since the development of nonbacterial pyospermia in previously nonpyospermic men treated with clomiphene citrate (CC) has been observed, and nonbacterial prostatitis has been after antiestrogen treatment in an animal model, we sought characterize the occurrence of nonbacterial pyospermia in men treated with CC. PATIENTS AND METHODS: Forty-two nonpyospermic men with low serum testosterone levels treated with 25 mg CC/day were retrospectively compared to 27 untreated nonpyospermic men referred for infertility evaluation. RESULTS: Spontaneous nonbacterial pyospermia developed in CC-treated men [14.3%] at rate nearly twice that observed in controls [7.4%]. Serum testosterone increased in CC-treated men, both pyospermic and nonpyospermic. However, only CC-treated, nonpyospermic men demonstrated improvement in semen characteristics. CC-treated men who developed pyospermia were older than nonpyospermic men [pyospermic, 41.7 +/- 8.1 years; nonpyospermic, 35.6 +/- 4.9 years-P < .01). Men over 35 years of age were over six times as likely to develop pyospermia as men under 35 years of age (P < .05). Eight nonpyospermic, CC-treated men (8/36, 22.2%) have contributed to pregnancies leading to live births, whereas no pyospermic man has done so. CONCLUSION: These findings support an association between a nonbacterial inflammatory response of the human male reproductive tract and CC treatment. This pyospermia may occur without significant deterioration of semen characteristics and with an appropriate response to treatment in terms of serum testosterone level. Men over the age of 35 are statistically more likely to develop pyospermia with this therapy. Our results suggest that clomiphene citrate-associated pyospermia has a negative effect on male fertility.

Adult↗
PubMedDate not supplied

A multisite field test of the acceptability of physical activity counseling in primary care: project PACE.

Primary health-care providers have been encouraged to counsel their patients about regular physical activity, but there are significant barriers to effective counseling. In this study a program of training and materials was tested for acceptability to providers, office staff, and patients. Primary care providers and office staff were trained to use the Physician-based Assessment and Counseling for Exercise (PACE) materials in four geographical sites in the United States. The program was tested in a variety of settings and with diverse patient populations. The acceptability of the program during a five-month study period was evaluated through structured interviews. The training was effective in preparing the providers to counsel, and the program was generally acceptable to providers, office staff, and patients. Counseling was provided in less than five minutes by 70% of providers, and most patients reported following the recommendations given. The PACE program assists providers in overcoming barriers to counseling patients about physical activity. The PACE program is potentially an important part of a national effort to enhance the adoption and maintenance of physical activity among adults.

Adult↗
PubMedDate not supplied

[Vascular iatrogenic lesions in surgery (author's transl)].

The authors report 93 cases of iatrogenic vascular lesions. Thirty-one were secondary to catheterizations and angiography, 10 resulted from accidental intra-arterial or intravenous injections of irritant chemicals, 15 resulted from various operations mainly vascular surgery. Visceral or pelvic ischemias after surgery on the aortic bifurcation are analyzed for symptoms and treatment.

Aneurysm↗
PubMedDate not supplied

The National Depressive and Manic-Depressive Association consensus statement on the undertreatment of depression.

OBJECTIVE: A consensus conference on the reasons for the undertreatment of depression was organized by the National Depressive and Manic Depressive Association (NDMDA) on January 17-18, 1996. The target audience included health policymakers, clinicians, patients and their families, and the public at large. Six key questions were addressed: (1) Is depression undertreated in the community and in the clinic? (2) What is the economic cost to society of depression? (3) What have been the efforts in the past to redress undertreatment and how successful have they been? (4) What are the reasons for the gap between our knowledge of the diagnosis and treatment of depression and actual treatment received in this country? (5) What can we do to narrow this gap? (6) What can we do immediately to narrow this gap? PARTICIPANTS: Consensus panel members were drawn from psychiatry, psychology, family practice, internal medicine, managed care and public health, consumers, and the general public. The panelists listened to a set of presentations with background papers from experts on diagnosis, epidemiology, treatment, and cost of treatment. EVIDENCE: Experts summarized relevant data from the world scientific literature on the 6 questions posed for the conference. CONSENSUS PROCESS: Panel members discussed openly all material presented to them in executive session. Selected panelists prepared first drafts of the consensus statements for each question. All of these drafts were read by all panelists and were edited and reedited until consensus was achieved. CONCLUSIONS: There is overwhelming evidence that individuals with depression are being seriously undertreated. Safe, effective, and economical treatments are available. The cost to individuals and society of this undertreatment is substantial. Long suffering, suicide, occupational impairment, and impairment in interpersonal and family relationships exist. Efforts to redress this gap have included provider educational programs and public educational programs. Reasons for the continuing gap include patient, provider, and health care system factors. Patient-based reasons include failure to recognize the symptoms, underestimating the severity, limited access, reluctance to see a mental health care specialist due to stigma, noncompliance with treatment, and lack of health insurance. Provider factors include poor professional school education about depression, limited training in interpersonal skills, stigma, inadequate time to evaluate and treat depression, failure to consider psychotherapeutic approaches, and prescription of inadequate doses of antidepressant medication for inadequate durations. Mental health care systems create barriers to receiving optimal treatment. Strategies to narrow the gap include enhancing the role of patients and families as participants in care and advocates; developing performance standards for behavioral health care systems, including incentives for positive identification, assessment, and treatment of depression; enhancing educational programs for providers and the public; enhancing collaboration among provider subtypes (eg, primary care providers and mental health professionals); and conducting research on development and testing of new treatments for depression.

Antidepressive Agents↗
PubMedDate not supplied

The acid-fast stain is a superior stain for use in the mean mature spermatid count for testicular biopsies.

The mean mature spermatid count (MMSC) provides a useful, simplified quantitative evaluation of human spermatogenesis that is based on the number of mature spermatids in histological sections of testicular biopsies. Here, the activity of the acid-fast (AF) stain was compared to that of the usual hematoxylin and eosin (H&E) stain in performing the MMSC. Thirty bilateral testicular biopsies showing normal spermatogenesis were chosen retrospectively from 15 subfertile patients with obstructive azoospermia or severe oligospermia. The MMSC was determined on each biopsy by utilizing both H&E and AF stains. The AF stain proved to be specific for the mature spermatids normally counted for the MMSC. It simplified recognition of mature spermatids, thereby shortening the overall time required for the procedure. The mean AF MMSC was lower than the mean H&E MMSC, and the mean interobserver differences were decreased. The AF stain is a superior stain for the MMSC when used in conjunction with the H&E stain for descriptive histology.

Adult↗
PubMedDate not supplied

Indications for corticosteroids prior to epididymal sperm retrieval.

OBJECTIVE: To evaluate the effectiveness of low-dose intermittent prednisone treatment designed to reduce antisperm antibodies for men prior to epididymal sperm retrieval and in vitro fertilization. STUDY DESIGN: This was a retrospective review of 75 subfertile men with reproductive obstruction due to congenital absence of the vas deferens, or other reproductive tract obstruction, who underwent a total of 98 episodes of microsurgical epididymal sperm aspiration (MESA) with in vitro fertilization. RESULTS: For couples in whom the man was pretreated with prednisone, better fertilization rates (39% vs. 21%, P < .0001) and pregnancy rates (48% vs. 26%, p = 0.06) were obtained than in couples in whom the man was not pretreated. The benefit of prednisone treatment was most noticeable for men with preoperatively detectable antisperm antibodies. Prednisone-treated men with preoperative antisperm antibodies showed improved fertilization rates (40% vs. 9%, p = 0.005). Men without antibodies who were treated with prednisone showed a decrement in fertilization rate, from 73% to 24% (fertilizations per oocyte, P < .0005). Success of prednisone treatment could not be correlated with specific assisted-reproduction technique (IVF, PZD, SuZI, or ICSI). CONCLUSIONS: Preoperative evaluation of antisperm antibody status and treatment of antibody-positive men prior to epididymal sperm retrieval may play a role in improvement of the fertilization and pregnancy results achieved by centers that provide MESA with assisted reproduction. These results are most important when MESA is performed without the assistance of intracytoplasmic sperm injection. Empiric treatment with prednisone may be detrimental to the fertility of men who have no antisperm antibodies.

Adult↗