Biomedical subjects
M J Goldman
Publications and source records attributed to M J Goldman.
Kleptomania: making sense of the nonsensical.
OBJECTIVE: Kleptomania, or the irresistible impulse to steal unneeded objects, is a poorly understood disorder. The objectives of this paper are to critically review and integrate existing data and to make suggestions for further research. DATA COLLECTION: Information was gathered by reviewing the English-language literature on kleptomania. Cases were chosen for review that approximated the diagnosis as defined in DSM-III-R. These cases were analyzed in terms of their relationship to previous theories about the disorder, and larger relevant studies were examined. Using the data organized into a table, the author explores areas of convergence and disagreement and discusses the methodological difficulties of the different studies. FINDINGS: Kleptomania is more common than previously thought. The "typical" individual with kleptomania is a 35-year-old woman who began to steal when she was 20 years old. Her thefts bring both relief and guilt. She probably has not sought treatment on her own but suffers from a necessary, pervasive, repetitive, and self-destructive act. She may have a history of sexual dysfunction or sexual preoccupation and may be unhappily married to an emotionally unsupportive husband. She has been labile and dysphoric for many years and may have a personality disorder. She has probably had a tumultuous, stressful childhood and may dissociate. CONCLUSIONS: The author proposes a biopsychosocial model of the etiology of kleptomania based on data from the literature. This model emphasizes possible childhood abuse as a precipitating factor in later development of kleptomania. More complete research is needed in the study of kleptomania.
Hypomania and elation: a diagnostic dilemma.
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Bruxism and sexual abuse: a possible association?
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Ritualistic use of fluoxetine by a former substance abuser.
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An objective appraisal of the role of computed tomographic (CT) guided drainage of intra-abdominal abscesses.
Computed tomographic (CT) guided drainage is an important tool in the treatment of intra-abdominal abscess. Its most important role is in the treatment of small, unilocular, well-placed abscesses. Success rates in our experience diminish considerably in abscesses involving necrotic tumors or those infected with yeast. As is frequently characteristic of new technologic procedures, the initial evaluation of the success rate of the procedure is overly optimistic. The procedure carries a considerable complication rate (13%) and mortality rate (15%). Most importantly, success is usually evident early; within the first 24 to 48 hours. After this length of time, careful evaluation to consider further treatment should be contemplated.
Structure and regulation of the avian gene for fatty acid synthase.
Starvation, glucagon and cyclic AMP inhibit, and refeeding starved animals and insulin or IGF-I plus triiodothyronine stimulate accumulation of FAS and its mRNA in liver; transcription is the primary regulated step. In the uropygial gland, differentiation of basal cells into mature sebocytes is accompanied by the accumulation of large amounts of FAS and its mRNA. By analogy with liver, transcription is likely to be the regulated step, but direct experimental evidence for this hypothesis is lacking. FAS mRNA is a unique gene and is probably more than 100 kb in length. The FAS gene of goose and duck is transcribed into two mature mRNAs of about 10,800 and 12,200 nucleotides. The 3'-untranslated regions of the FAS mRNAs contain an unusual polypyrimidine tract which, at the mRNA level at least, appears unrelated to regulation of gene expression. Polypyrimidine tracts similar in sequence to that in the FAS gene are found in about 20 different parts of the genome. All of the fragments which contain these tracts are hypermethylated. The next stage of this investigation will involve identification of cis-acting sequence elements in the FAS gene which specify responses to diet, hormones and tissue-specific regulatory factors. Isolation and characterization of the 5'-ends of the cDNA and the gene are underway.
Computed tomography guidance for skeletal biopsy.
Computed tomographic (CT) guided biopsy and abscess drainage of multiple organ systems have been well described. Reports of spinal and skeletal applications have been less common. This study describes the use of CT guidance in the biopsy of various skeletal lesions in 46 patients. Forty-one patients had skinny needle aspirations (18 or 22 gauge) and 23 patients had trephine core biopsies. Sites of the lesions included: thoracic spine-15 patients, lumbosacral spine-17 patients, bony pelvis-6 patients, rib-2 patients, and long bones-6 patients. Fast scanners capable of rapid image reconstruction have overcome many constraints. With CT guidance, the physician who performs the procedure receives virtually no ionizing radiation. The exact location of the needle tip is accurately visualized in relation to the lesion being biopsied and to the vital organs.
The fatty acid synthase gene in avian liver. Two mRNAs are expressed and regulated in parallel by feeding, primarily at the level of transcription.
The rates of synthesis of fatty acid synthase and the levels of its mRNA are high in livers of chicks, ducklings, or goslings fed high-carbohydrate mash diets and low in livers of starved birds, indicating pretranslational regulation of fatty acid synthase activity. Determination of the step(s) at which the nutritional state regulates the fatty acid synthase mRNA level was the objective of this study. Total RNA extracted from gosling or duckling liver contains two discrete fatty acid synthase transcripts, one of about 12,200 nucleotides and the other about 10,800 nucleotides. Both mRNAs are transcribed from the same gene because there is only one fatty acid synthase gene/haploid genome. A combination of 1) comparison of restriction fragment lengths in genomic DNA and cloned fatty acid synthase cDNAs, 2) differential hybridization of cloned cDNAs to the two mRNAs, and 3) sequence analysis indicates that the longer mRNA is a 3'-extension of the shorter one. The half-lives for fatty acid synthase mRNAs in fed ducklings and in starved ducklings were estimated from the rate at which mRNA level approached steady state during starvation or refeeding. The amount of fatty acid synthase mRNA in total liver RNA increased rapidly when starved ducklings were fed a high-carbohydrate mash diet, reaching an apparent steady state of 10 times the initial level after 9 h. The kinetics of accumulation suggested a half-life of 4-6 h for fatty acid synthase mRNA in fed ducklings. When fed ducklings were starved, fatty acid synthase mRNA decayed with a half-life of about 3 h. Therefore, the half-life for fatty acid synthase mRNA appeared to be little affected by feeding or starvation. The levels of both mRNAs changed in parallel indicating that half-lives of the two mRNAs were not regulated differentially. Transcription of the fatty acid synthase gene, as measured in isolated nuclei, increased about 10-fold when starved ducklings were refed for 24-30 h. Most of the increase in transcription occurred within 45 min after feeding was initiated. However, when fed ducklings were starved, the initial decrease in fatty acid synthase mRNA level occurred more rapidly than the decrease in transcription of the fatty acid synthase gene, indicating some degree of post-transcriptional regulation. Nevertheless, after 48 h of starvation, both mRNA level and transcription were decreased to the same extent. Nutritional state, therefore, regulates the transcription of two fatty acid synthase mRNAs from a unique gene. In addition, transient regulation occurs at an as yet undefined post-transcriptional step.
Metastasis to the choroid of the eye from carcinoma of the breast.
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Detection of postcardiotomy bacterial pericarditis with gallium-67 citrate.
A 46-year-old man who had undergone apical cardiac aneurysmectomy with a ventriculotomy graft and implanted automatic cardioverter-defibrillator electrodes, presented with fever, left-sided pleuritic chest pain, and a draining sinus. A Ga-67 scan was performed to aid in determining whether the infection was limited to the chest wall or if it had penetrated deeper to the cardiac structures. Uptake of gallium within the cardiac region, in association with minimal rib uptake of Tc-99m MDP, strongly supported the existence of infection within the pericardium. CT scan demonstrated a pericardial collection which under CT-guided aspiration proved to be purulent. Definitive surgical drainage was performed, and the patient was discharged 4 weeks postoperatively. Ga-67 imaging can provide an accurate and relatively rapid means of localizing infection in the postcardiotomy patient. A thorough bibliography of pericardial gallium uptake is provided.
Regulation of genes for enzymes involved in fatty acid synthesis.
The levels of malic enzyme and fatty acid synthase are increased by feeding and decreased by starvation in liver in vivo and are increased by triiodothyronine and decreased by glucagon in hepatocytes in culture. Cloned malic enzyme and fatty acid synthase cDNAs are being used to analyze regulation of these unique genes. Dietary regulation of both enzymes occurs at pretranslational steps. Increased transcription and increased mRNA stability contribute about equally to a 20-fold increase in malic enzyme mRNA level when starved ducklings are refed. In contrast, a 10-fold increase in the level of fatty acid synthase mRNA is largely accounted for by increased transcription of this gene. In chick-embryo hepatocytes incubated in serum-free medium containing insulin, triiodothyronine causes a greater than 10-fold increase in levels of both malic enzyme and fatty acid synthase mRNAs. Kinetic and inhibitor experiments suggest a protein intermediate in the increases of malic enzyme and fatty acid synthase mRNAs caused by triiodothyronine. For malic enzyme, the stimulation by triiodothyronine is predominantly posttranscriptional. Glucagon decreases the level of malic enzyme mRNA by 90 to 95%, with regulation occurring at a posttranscriptional step. Inhibitor experiments suggest that stimulation of the degradation of malic enzyme mRNA is partially responsible. Glucagon inhibited fatty acid synthase mRNA level by less than 50%; the inhibited step has not been identified. Thus, the coordinated regulation of malic enzyme and fatty acid synthase proteins by nutritional state may involve different hormones regulating at different points. A surprisingly large component of the regulation is posttranscriptional.
Effect of periodontal therapy on patients maintained for 15 years or longer. A retrospective study.
A retrospective study of tooth loss in 211 patients who were treated for periodontal disease in private practice and maintained for 15 to 34 years on 3- to 6-month recall schedules is reported. The average age of the patients was 42 years, and the average length of time in maintenance was 22 years. On the basis of response to therapy, the patients were classified as Well-Maintained (62%), Downhill (28%) and Extreme Downhill (10%). Seven hundred and seventy-one (771) teeth were lost (13.4%) due to all causes. Molar teeth are the most prone to loss and the mandibular cuspid is the most resistant. The importance of maintenance therapy is emphasized.
Nutritional regulation of the synthesis and degradation of malic enzyme messenger RNA in duck liver.
The amount of malic enzyme mRNA in total liver RNA increased rapidly when starved ducklings were fed a high-carbohydrate mash diet, reaching 15 times the initial level at 9 h and an apparent steady state, about 20 times the initial level, at 24 h. Based on the kinetics of accumulation, malic enzyme mRNA had a half-life of 3-5 h in the livers of fed ducklings. When fed ducklings were starved, malic enzyme mRNA decreased with a half-life of about 1 h. Feeding, therefore, may have inhibited the degradation of malic enzyme mRNA, but not sufficiently to account for the 20-fold increase in mRNA level. The level of malic enzyme sequences in nuclear RNA increased severalfold when starved ducklings were fed, consistent with a stimulation of transcription. The rate of transcription of the malic enzyme gene, as measured in isolated nuclei, increased 3-5-fold when starved ducklings were refed. Starvation of fed animals caused a 55-65% inhibition of the transcription of the malic enzyme gene. Synthesis of albumin mRNA was little affected by refeeding or starvation, indicating that the observed effects on synthesis of malic enzyme mRNA were selective. We conclude that both increased transcription and decreased degradation contribute to the 20-fold increase in malic enzyme mRNA caused by feeding starved ducklings.
Achalasia complicated by esophagobronchial fistula.
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Human lymphocyte antigen haplotype and resistance to periodontitis.
Certain human lymphocyte antigen (HLA) haplotypes have been correlated with the presence of certain diseases. To date no significant relationship between periodontitis and HLA haplotype has been demonstrated. The purpose of this study was to determine the frequency of HLA-A, HLA-B and HLA-C haplotypes in patients resistant to chronic periodontitis and to determine if there is any association between specific HLA genes and periodontal health. Twenty-five healthy individuals who demonstrated a high resistance to periodontal disease (mean age 49.9 years) were matched to 25 subjects with chronic periodontitis and to a periodontally undiagnosed population of 22,000 individuals. Peripheral blood was taken and HLA specificity was determined by the microlymphocytotoxicity test. The results indicated a statistically significant increase in the occurrence of HLA-B5 (P = 0.0059) and a trend in the occurrence of HLA-A28 (P = 0.0565) in those patients resistant to periodontal disease when compared to the matched controls. When compared to the large random control group, a significant correlation was observed for HLA-A28 (P less than 0.01) in blacks and HLA-B5 (P less than 0.01) in whites. It is possible that the HLA-A28 and the HLA-B5 individual may have the ability to resist the progression of chronic periodontitis.
The electrocardiographic diagnosis of myocardial infarction in the presence of ventricular conduction defects. A new attempt to solve an old problem.
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Radionuclide imaging and computed tomography in renal oncocytoma.
Renal oncocytoma is an apparently benign neoplasm that is being reported with increasing frequency. It is important to differentiate it from renal-cell carcinoma prior to surgery. Angiographic, CT, and ultrasound studies may suggest the diagnosis but are not pathognomonic. In 4 cases, 99mTc-glucoheptonate imaging of the renal tubules was performed; one patient was also scanned in 131I-orthoidohippurate. There was no evidence of radionuclide uptake by the tumor. Reasons for the lack of success in differentiating renal oncocytoma from renal-cell carcinoma are discussed.