Search PubMed⌕ Search

Biomedical subjects

M Goodman

Publications and source records attributed to M Goodman.

At least 73 records · Page 4Linked to original sources
PubMed1999

Endoscopic thoracic sympathectomy for primary palmar hyperhidrosis: intermediate term results.

BACKGROUND: The authors' experience of the efficacy and safety of endoscopic thoracic sympathectomy in the treatment of primary palmer hyperhidrosis was examined. METHODS: A retrospective study of 71 patients (126 sympathectomies) was undertaken. Data were retrieved by hospital records and telephone interview. RESULTS: Follow-up was possible for 92 sympathectomies in 53 patients. Overall, satisfactory results were achieved in 93% of patients and complications were uncommon. Compensatory hyperhidrosis was the most common complication, which occurred in 64% of patients; the trunk and feet were the most common sites. Horner's syndrome occurred in five patients, although in two it was a permanent complication. No patient expressed dissatisfaction with the procedure as a consequence of this complication. Pneumothorax occurred in 17.5% of cases, although the vast majority were incidental findings on a postoperative chest X-ray, and none required drainage. With the newer techniques of access, patient dissatisfaction with the cosmetic appearance has fallen from 27.3 to 6.4%. Overall 90% of patients said they would have the operation again, which represents a high level of patient satisfaction. CONCLUSIONS: Endoscopic thoracic sympathectomy is a safe and effective technique for primary palmer hyperhidrosis. Evolution of the technique has resulted in improvement in patient satisfaction.

Adolescent↗
PubMed1999

Molecular evolution of the COX7A gene family in primates.

COX VIIa is one of 10 nuclear-encoded subunits of the COX holoenzyme, and one of three that have isoforms with tissue-specific differences in expression. Analysis of nucleotide substitution rates revealed an accelerated rate of nonsynonymous substitutions relative to that of synonymous substitutions for the heart isoform gene (COX7AH) in six primate lineages. Rate accelerations have been noted for four other COX-related genes in this time period, suggesting that the COX holoenzyme has experienced an episode of adaptive evolution. A third member of the gene family, COX7AR, has recently been described. Although its function is currently unknown, low nonsynonymous substitution/synonymous substitution (N/S) ratios in mammalian evolution suggest that COX7AR is of functional importance. When the COX7A isoforms were divided into domains, examination of nucleotide substitution rates suggested that mitochondrial targeting residues experienced an accelerated nonsynonymous substitution rate in the period following gene duplication. In contrast, paralogous comparisons of the targeting residues of each isoform show they have been relatively conserved in mammalian evolution. This pattern is consistent with the evolution of tissue-specific function.

Amino Acid Sequence↗
PubMed1999

The relative influences of symptoms, insight, and neurocognition on social adjustment in schizophrenia and schizoaffective disorder.

Impaired insight and neurocognitive deficits are commonly seen in schizophrenia. No study to date, however, has documented the relative influences of insight deficits, neurocognitive functioning, and psychotic symptoms on overall social adjustment in this population. This was done in a cohort of individuals recovering from acute exacerbations. Forty-six individuals with schizophrenia or schizoaffective disorder were recruited upon discharge from an inpatient unit. Symptom levels, neurocognitive functioning (information processing, memory, and executive functioning), and symptom awareness were documented, and social adjustment was assessed in three domains: treatment compliance, social behavior, and subjective quality of life. Cross-sectional data from initial assessments are reported. Sequential linear regression analyses identified differential associations between illness characteristics and outcome domains. Treatment compliance was most influenced by insight; social behavior deficits were associated with thought disorder and neurocognitive (working memory and visuo-spatial) impairments; and quality of life was associated with mood disturbances. Outcome is multidimensional in schizophrenia, and there are differential patterns of associations between illness characteristics and domains of social adjustment. Studies such as this can guide clinicians in determining the most appropriate treatments for specific individuals and should also guide researchers in efforts to clarify the processes that underlie treatment response and recovery in schizophrenia.

Adult↗
PubMed1999

Health-related quality-of-life assessment of patients with life-threatening ventricular arrhythmias.

The purpose of this study was to determine whether treatments for life-threatening ventricular arrhythmias are associated with quality-of-life (QOL) and psychological distress. Multidimensional measures of QOL and psychological distress were used to cross-sectionally compare patients with ICDs to patients treated with antiarrhythmic drugs and patients without serious cardiac conditions. The sample consisted of 157 patients: 35 patients treated with antiarrhythmic medication only, 24 patients treated with ICD only, 25 patients treated with ICD and antiarrhythmic medication, and 73 controls. Patients completed the Medical Outcomes Study SF-36 health survey, the Brief Symptom Inventory, and background questionnaires. There were no significant differences in self-reported QOL and psychological distress between patients with or without ICD, and the occurrence of defibrillator shocks was unrelated to QOL and psychological distress. However, patients treated with antiarrhythmic drugs reported greater QOL impairment in physical functioning, vitality, emotional role limitations, and sleep, as well as greater psychological distress than patients not treated with antiarrhythmics. These limitations may be attributed to adverse effects arising from antiarrhythmic pharmacotherapy. Results of the present investigation suggest that QOL and psychological distress are maintained among ICD patients, whereas treatment with antiarrhythmic drugs are associated with a diminished QOL and greater psychological distress. These findings may assist cardiologists to select the optimal treatment for life-threatening ventricular arrhythmias that minimizes disturbances in health-related QOL and psychological distress and increases patient compliance.

Activities of Daily Living↗
PubMed1999

Characterization of V3 sequence heterogeneity in subtype C human immunodeficiency virus type 1 isolates from Malawi: underrepresentation of X4 variants.

We have examined the nature of V3 sequence variability among subtype C human immunodeficiency virus type 1 (HIV-1) sequences from plasma-derived viral RNA present in infected men from Malawi. Sequence variability was assessed by direct sequence analysis of the V3 reverse transcription-PCR products, examination of virus populations by a subtype C V3-specific heteroduplex tracking assay (V3-HTA), and selected sequence analysis of molecular clones derived from the PCR products. Sequence variability in V3 among the subtype C viruses was not associated with the presence of basic amino acid substitutions. This observation is in contrast to that for subtype B HIV-1, where sequence variability is associated with such substitutions, and these substitutions are determinants of altered coreceptor usage. Evolutionary variants in subtype C V3 sequences, as defined by the V3-HTA, were not correlated with the CD4 level in the infected person, while such a correlation was found with subtype B V3 sequences. Viruses were isolated from a subset of the subjects; all isolates used CCR5 and not CXCR4 as a coreceptor, and none was able to grow in MT-2 cells, a hallmark of the syncytium-inducing phenotype that is correlated with CXCR4 usage. The overall sequence variability of the subtype C V3 region was no greater than that of the conserved regions of gp120. This limited sequence variability was also a feature of subtype B V3 sequences that do not carry the basic amino acid substitutions associated with altered coreceptor usage. Our results indicate that altered coreceptor usage is rare in subtype C HIV-1 isolates in sub-Saharan Africa and that sequence variability is not a feature of the V3 region of env in the absence of altered coreceptor usage.

Base Sequence↗
PubMed1999

Jamaica's measles elimination experience.

OBJECTIVES: This article describes the effort to eliminate measles from Jamaica and its impact on measles incidence. METHODS: In addition to routine measles vaccination, the Jamaican Ministry of Health implemented a strategy of a 1-time-only catch-up vaccination campaign, conducted in 1991, and periodic follow-up campaigns, the first of which occurred in 1995. RESULTS: Since 1991, despite careful surveillance, no serologically confirmed indigenous cases of measles have occurred in Jamaica. CONCLUSIONS: Measles virus circulation has been interrupted in Jamaica. The Jamaican experience provides further evidence that global measles eradication is achievable.

Adolescent↗
PubMed1999

The health and economic benefits of influenza vaccination for healthy and at-risk persons aged 65 to 74 years.

OBJECTIVE: The objective of this study was to assess the health and economic benefits of influenza vaccination in both healthy and at-risk seniors aged 65 to 74 years. DESIGN AND SETTING: We used administrative claims data from 6 consecutive serial cohorts spanning the years 1990 to 1991 through 1995 to 1996. All members of a Twin-Cities managed care organisation who were > or = 65 years of age for the respective study year were included in each cohort. Other information obtained included demographic characteristics, baseline comorbidities, prior resource utilisation, and influenza vaccination status. Study outcomes included hospitalisations for pneumonia and influenza and for all respiratory conditions and death. Economic analyses assumed the societal perspective and included both direct and indirect costs. MAIN OUTCOME MEASURES AND RESULTS: During the 6 study seasons, there were 100 195 person-periods of observation for persons aged 65 to 74 years. Of these, two-thirds were healthy and one-third had at least one major baseline comorbidity. Influenza vaccination was associated with reductions in hospitalisations for pneumonia and influenza and for all respiratory conditions in both healthy and at-risk groups, although the results did not reach statistical significance among the healthy individuals. Vaccination was also associated with significant reductions in the risk of death for both groups. The economic analysis demonstrated that vaccination against influenza in the base case was associated with direct and total cost savings for both healthy and at-risk seniors aged 65 to 74 years. CONCLUSION: Influenza vaccination of healthy and at-risk seniors aged 65 to 74 years is associated with substantial health benefits and is cost saving. These findings support age-based vaccination strategies for all persons > or = 65 years of age.

Aged↗
PubMed1999

Efficacy of jejunogram after jejunostomy insertion.

The era of managed care has spawned a national debate over the allocation of health care resources. We hypothesized that routine postjejunostomy jejunogram rarely provides additional clinical information or changes patient management and, therefore, is unwarranted. We retrospectively reviewed the charts of 128 consecutive patients undergoing feeding jejunostomy tube insertion between January 1995 and December 1996. All patients had postinsertion jejunograms. Eighty-five (66%) of the jejunograms were performed after operative insertion of the jejunostomy, and 43 (33%) were performed after percutaneous reinsertion of a previously placed jejunostomy. Data extracted from the charts include age, sex, indication for jejunogram, length of time prior jejunostomy was in place at time of reinsertion, and results of jejunogram. There were no patients (0%) with misplaced jejunostomy or extravasation of dye, as noted on jejunogram. There were no management changes implemented as a result of jejunogram readings (P < <0.05). The use of routine jejunogram after operative insertion or reinsertion of a prior jejunostomy that has become dislodged or occluded does not alter patient management, incurs unnecessary costs, and, therefore, is unwarranted.

Adolescent↗
PubMed1999

Use of three-dimensional microscopy with multiple oblique illumination in evaluating cytopathology preparations.

OBJECTIVE: To analyze whether the use of multiple oblique illumination (MOI), in contrast to axial illumination (AI), improves imagery in bright field microscopy. Specimens containing thick cell clusters, such as cervical Pap smears, are often misread because of out-of-focus cell clusters. We hypothesized that visualization of these specimens with MOI would enhance this information as compared with AI. STUDY DESIGN: Micrometer images and Pap smears were analyzed in focus, and 8 and 40 microns out of focus by MOI and AI. All fields were captured to a remote computer, histograms were constructed, and mean light intensity was calculated. Mathematical formulation was used to define the histogram distribution of the micrometer images. Statistical analysis was performed using one-way ANOVA and Newman-Keuls test. RESULTS: K(focus) was improved (P < .01) and at 20 and 40 microns out of focus, mean light intensities were greater (P < .003, P < .05, respectively) with MOI as compared to AI. CONCLUSION: MOI improves out-of-focus information by increasing light penetration through the specimen and enhancing contrast and resolution.

Female↗
PubMed1998

Conformational analyses of somatostatin-related cyclic hexapeptides containing peptoid residues.

We report the conformational analysis by 1H NMR in DMSO and computer simulations involving distance geometry and molecular dynamics simulations of a series of peptoid analogues of the cyclic hexapeptide c[Phe11-Pro6-Phe7-d-Trp8-Lys9-Thr10] (1). The proline residue in compound 1 is replaced with the peptoid residues N-benzylglycine (Nphe) (compound 2), N-(S)-alpha-methylbenzylglycine [(S)-beta-MeNphe] (compound 3), and N-(R)-alpha-methylbenzylglycine [(R)-beta-MeNphe] (compound 4). The peptoid analogues 2 and 4 exhibit potent binding activities to the hsst2 receptor, while the binding affinities to the hsst5 and to the hsst3 receptors are reduced compared to that of the parent compound 1. Compound 3 shows reduced binding activities to the hsst2, hsst3, and hsst5 receptors compared to compound 1. The results of in vivo assays indicate that these compounds inhibit the growth hormone release but do not affect the insulin release. These peptoid-containing analogues show two sets of NMR signals corresponding to cis and trans conformations of the peptide bond between Phe11 and Nxaa6. We demonstrate that the backbone conformation and the orientation of the relevant side chains of compound 1 are maintained in the cis isomers of the peptoid analogues which adopt a type VI beta-turn centered around residues 11 and 6 and a type II' beta-turn with d-Trp in the i+1 position. The enhanced selectivity of the peptoid-containing analogues compared to compound 1 and the results of the conformational analysis suggest that the presence of a conformationally constrained hydrophobic group in position 6 in complementary topology to the Phe11 side chain enhances selective binding to the hsst2 receptor.

Computer Simulation↗
PubMed1998

Design, synthesis, and biological activities of potent and selective somatostatin analogues incorporating novel peptoid residues.

We report the synthesis, bioactivity, and structure-activity relationship studies of compounds related to the Merck cyclic hexapeptide c[Pro6-Phe7-d-Trp8-Lys9-Thr10-Phe11], L-363,301 (the numbering in the sequence refers to the position of the residues in native somatostatin). The Pro residue in this compound is replaced with arylalkyl peptoid residues. We present a novel approach utilizing beta-methyl chiral substitutions to constrain the peptoid side-chain conformation. Our studies led to molecules which show potent binding and increased selectivity to the hsst2 receptor (weaker binding to the hsst3 and hsst5 receptors compared to L-363, 301). In vivo, these peptoid analogues selectively inhibit the release of growth hormone but have no effect on the inhibition of insulin. The biological assays which include binding to five recombinant human somatostatin receptors carried out in two independent laboratories and in vivo inhibition of growth hormone and insulin provide insight into the relationship between structure and biological activity of somatostatin analogues. Our results have important implications for the study of other peptide hormones and neurotransmitters.

Animals↗
PubMed1998

Synthesis and biological activity of a novel methylamine-bridged enkephalin analogue (MABE): a new route to cyclic peptides and peptidomimetics.

The synthesis and biological activity of a methylamine-bridged enkephalin analogue (MABE) is presented. The key step in the synthesis of the target compound involves the ring opening of Cbz-d-serine beta-lactone with Boc-Phe-NHCH2CH2NHCH3. Further synthetic elaboration of the resulting building block yielded compound 1 (MABE, Tyr-c[(NbetaCH3)-D-A2pr-Gly-Phe-NHCH2CH2-], where A2pr is a 2,3-diaminopropionic acid residue). Utilizing a combination of NMR and molecular modeling, the structure-biological activity relationships for compound 1 were studied. Using an in vitro isolated receptor assay, MABE was found to have affinities for isolated mu delta, and kappa opioid receptors of 1.6, 2.1, and 340 nM, respectively. By an in vivo thermal escape assay, MABE was found to have an ED50 of 0.027 microg in the rat when administered intrathecally. This effect was reversed by naloxone. By comparison, DAMGO, morphine, and DPDPE were found to yield ED50 values of 0.14, 2.4, and 54 microg, respectively, in the same assay.

Analgesics, Opioid↗
PubMed1998

Poor mental development in patients with tuberous sclerosis complex: clinical risk factors.

OBJECTIVE: To identify clinical risk factors for poor mental development among patients with tuberous sclerosis complex (TSC). DESIGN: Case-control analysis of a clinic population. SETTING: Specialty clinic in a hospital. PATIENTS: One hundred six patients with TSC consecutively seen between January 1984 and December 1995 at the Child Neurology Clinic of the Children's Memorial Health Institute in Warsaw, Poland. STUDY VARIABLES: Seizure type, age at seizure onset, sex, and history of diphtheria, tetanus, and pertussis immunization. MAIN OUTCOME MEASURE: Moderate to profound developmental delays. RESULTS: Seizure type (ie, infantile spasms) was the only analyzed risk factor that showed a consistent and independent association with poor mental development (adjusted odds ratio, 3.0; 95% confidence interval, 1.1-8.4; P =.03). Age at seizure onset, which initially showed a significant association with poor mental development, was no longer significantly associated after adjustment for seizure type (adjusted odds ratio, 1.6; P = .43). Neither sex (odds ratio, 1.1; P = .96) nor history of diphtheria, tetanus, and pertussis immunization (odds ratio, 1.0; P = .80) showed evidence of being a risk factor for poor mental development among patients with TSC. CONCLUSIONS: Infantile spasms, as the type of seizure on initial examination, is a significant risk factor for poor mental development in patients with TSC. Age at time of first seizure is not an independent risk factor but reflects the early ages at which these patients are seen with infantile spasms. Neither sex nor history of diphtheria, tetanus, and pertussis immunization is a risk factor for the subsequent development of poor mental development among patients with TSC.

Age of Onset↗
PubMed1998

Bilateral nasolacrimal duct obstruction managed with endoscopic techniques.

We present 3 cases of bilateral acquired nasolacrimal duct obstruction secondary to Wegener granulomatosis, sarcoidosis, and chronic lymphocytic leukemia. In all cases significant paranasal sinus and intranasal disease coincided with bilateral nasolacrimal duct obstruction. Surgical treatment of the nasolacrimal duct obstruction with dacryocystorhinostomy was more successful if the paranasal sinus disease was also treated. Nontraumatic bilateral nasolacrimal duct obstruction heralds unusual underlying systemic diseases, and coexisting paranasal sinus disease should be suspected. The simultaneous surgical treatment of both lacrimal and paranasal sinus disease through an endoscopic approach is advocated.

Adult↗