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Biomedical subjects

N Goldstein

Publications and source records attributed to N Goldstein.

At least 19 recordsLinked to original sources
PubMed2001

[Overuse of antibiotics with upper respiratory tract infections in a primary care clinic].

UNLABELLED: In the majority of cases upper respiratory tract infections (URI's) are caused by viruses. Nonetheless, in many instances, patients with URI's are over-treated with antibiotics. In order to evaluate the use of antibiotic therapy in patients with URI's, we recorded medications prescribed for URI's in 394 young adults seeking care in a primary care clinic. The following parameters were assessed: rhinnorhea, cough, sore throat, dysphagia, tonsillar exudates, tonsillar enlargement and cervical lymphadenopathy. Throat cultures were taken from all the patients. RESULTS: Antibiotic therapy was prescribed for 99 of the 370 patients (26.8%) with URI's and negative throat cultures. Among these patients, a high prevalence of the following findings was evident: tonsillar enlargement (66.7%), tonsillar exudates (48.5%), cervical lymphadenopathy (42.4%), lack of rhinorrhea (40.4%), lack of cough (32.0%) and fever (31.3%). CONCLUSIONS: Excess antibiotic therapy was prescribed for patients with URI's. Possible explanations are: clinical findings that suggest a diagnosis of follicular tonsillitis, early antibiotic treatment that is not based on throat cultures or antigen detection tests, and multiple treating physicians. RECOMMENDATIONS: We recommend that in cases of patients with URI's, antibiotics should not be prescribed unless diagnosis of a streptococcal infection is supported by results of throat cultures or antigen detection tests. Furthermore, in primary care clinics with a number of physicians, treatment should guarantee appropriate medical follow-up.

Adult↗
PubMed2000

[Altered functional and biochemical parameters during treatment of patients with bronchial asthma with inhaled gaseous superoxide].

To investigate the impact of adaptive oxidative training with inhaled gaseous superoxide (GS) on endogenous oxidative stress (EOS) and lung function in asthmatics and healthy volunteers, short-term GS inhalation was repeated. The study involved 27 patients (median age 42 (34 to 44) years with atopic bronchial asthma and a median disease duration of 130 (120 to 180) months prior to the investigation and 8 healthy volunteers whose median age was 20.5 (18 to 25 years). The rates of GS generation at a distance of 1 cm from the source was 0.25 mumol/min. The examinees inhaled GS nasally over 15 minutes per session, on an average of 20 times over 2 periods of 4 weeks each. Spirometric studies, a mathacholine challenge test, salbutamol test and blood cell count were performed, and blood antioxidative components were measured. There is evidence that GS inhalations in asthmatics cause an adaptive oxidative training and promote reductions in EOS, as well as activation of antiinflammatory mechanisms and improved spirometric parameters.

Administration, Inhalation↗
PubMed2000

Auditory deprivation modifies biological rhythms in the golden hamster.

To assess to what extent auditory sensory deprivation affects biological rhythmicity, sleep/wakefulness cycle and 24 h rhythm in locomotor activity were examined in golden hamsters after bilateral cochlear lesion. An increase in total sleep time as well as a decrease in wakefulness (W) were associated to an augmented number of W episodes, as well as of slow wave sleep (SWS) and paradoxical sleep (PS) episodes in deaf hamsters. The number of episodes of the three behavioural states and the percent duration of W and SWS increased significantly during the light phase of daily photoperiod only. Lower amplitudes of locomotor activity rhythm and a different phase angle as far as light off were found in deaf hamsters kept either under light-dark photoperiod or in constant darkness. Period of locomotor activity remained unchanged after cochlear lesions. The results indicate that auditory deprivation disturbs photic synchronization of rhythms with little effect on the clock timing mechanism itself.

Acoustic Stimulation↗
PubMed1999

Irradiation of the tumor bed alone after lumpectomy in selected patients with early-stage breast cancer treated with breast conserving therapy.

BACKGROUNDS AND OBJECTIVES: We present the interim findings of our in-house protocol treating the tumor bed alone after lumpectomy with low-dose-rate (LDR) interstitial brachytherapy in selected patients with early-stage breast cancer treated with breast conserving therapy (BCT). METHODS: From 1 March 1993 through 1 January 1995, 50 women with early-stage breast cancer were entered into a protocol of tumor bed irradiation alone using an interstitial LDR implant. Patients were eligible if their tumor was an infiltrating ductal carcinoma < or =3 cm in diameter, surgical margins were clear by at least 2 mm, the tumor did not contain an extensive intraductal component, the axilla was surgically staged with < or =3 nodes involved with cancer, and a postoperative mammogram was performed. Implants were positioned using a template guide delivering 50 Gy over 96 hr to the lumpectomy bed plus a 1-2-cm margin. Local control, cosmetic outcome, and complications were assessed. RESULTS: Patients ranged in age from 40 to 84 years (median, 65). The median tumor size was 10 mm (range, 1-25). Seventeen of 50 patients (34%) had well-differentiated tumors, 22 (44%) had moderately differentiated tumors, and in 11 (22%) the tumor was poorly differentiated. Forty-five patients (90%) were node-negative while five (10%) had 1-3 positive nodes. A total of 23 (46%) patients were placed on tamoxifen and 3 (6%) received adjuvant systemic chemotherapy. No patient was lost to follow-up. The median follow-up for surviving patients is 47 months (range, 37-59). No patient has experienced a local, regional, or distant failure. Three patients have died at 19, 33, and 39 months after treatment. All were without clinical evidence of recurrent disease and all deaths were unrelated to treatment. Good-to-excellent cosmetic results have been observed in 49 of 50 patients (98%) (median cosmetic follow-up was 44 months with a range of 19-59). No patient has experienced significant sequelae related to their implant. CONCLUSIONS: Interim results with treatment of the tumor bed alone with an LDR interstitial implant appear promising. Long-term follow-up of these patients and additional studies will be necessary to establish the equivalence of this treatment approach compared to standard BCT.

Adult↗
PubMed1999

[Audit and standardization of allergologic practices for urticaria].

In November 1997, by the initiative of allergists and ANAICE commissions of harmonization and allergy practice were created to improve the quality of care. The summary of the results is reported of one of the commissions, that on urticaria. The common attitudes and disagreements between the allergists from different faculties and who worked in different towns are presented. The work has also shown the importance of interactions between urticaria and mind in chronic urticaria in adults and has analysed invalidated indications. The work has obtained the support of the principal representative structures of liberal allergy: the SNAF, ANAFORCAL and ANAICE. It needs to be followed by scientific and rigorous methodology, like the audits of ambulatory medical practice. The harmonization commissions have done preliminary work which is indispensable for introduction of audits in the different sectors of activity in allergy.

Acute Disease↗
PubMed1998

Pain management.

Explore the source record for details and available documents.

Hawaii↗
PubMed1997

[International quality assurance standards (ISO 9002) in an Israeli hospital].

This hospital has been certified by the Israel Standards Institute as having a quality assurance system fulfilling the requirements of the international standard, ISO 9002. This is the first hospital in this part of the world to be certified as fulfilling this standard. Its adoption is one of several accepted approaches to quality assurance in medicine. World-wide, very few health organizations, including hospitals, have implemented this system successfully. Opinions regarding its importance are divided, mostly because of lack of experience in its application. We describe its features, goals and structure, and its implementation in various sectors, including health organizations. The process of its adoption, application and implementation is described, and the problems which arose are discussed.

Documentation↗
PubMed1997

Halting angiogenesis suppresses carcinoma cell invasion.

The importance of angiogenesis in malignant tumor growth has been interpreted mainly in terms of oxygen and nutrient supply. Here we demonstrate its fundamental role for tumor invasion of malignant human keratinocytes in surface transplants on nude mice. Distinct patterns of angiogenesis and vascular endothelial growth factor receptor-2 (VEGFR-2) expression allowed us to distinguish between benign and malignant cells. Functional inactivation of VEGF-R2 by a blocking antibody disrupted ongoing angiogenesis and prevented invasion of malignant cells, without reducing tumor cell proliferation. The reversion of a malignant into a benign phenotype by halting angiogenesis demonstrates a significant function of vascular endothelium for tumor invasion.

Animals↗
PubMed1997

Neutralizing antibodies against epidermal growth factor and ErbB-2/neu receptor tyrosine kinases down-regulate vascular endothelial growth factor production by tumor cells in vitro and in vivo: angiogenic implications for signal transduction therapy of solid tumors.

The overexpression in tumor cells of (proto)-oncogenic receptor tyrosine kinases such as epidermal growth factor receptor (EGFR) or ErbB2/neu (also known as HER-2) is generally thought to contribute to the development of solid tumors primarily through their effects on promoting uncontrolled cell proliferation. However, agents that antagonize the function of the protein products encoded by these (proto)-oncogenes are known to behave in vivo in a cytotoxic-like manner. This implies that such oncogenes may regulate critical cell survival functions, including angiogenesis. The latter could occur as a consequence of regulation of relevant growth factors by such oncogenes. We therefore sought to determine whether EGFR or ErbB2/neu may contribute to tumor angiogenesis by examining their effects on the expression of vascular endothelial cell growth factor (VEGF)/vascular permeability factor (VPF), one of the most important of all known inducers of tumor angiogenesis. We found that in vitro treatment of EGFR-positive A431 human epidermoid carcinoma cells, which are known to be heavily dependent on VEGF/VPF in vivo as an angiogenesis growth factor, with the C225 anti-EGFR neutralizing antibody caused a dose-dependent inhibition of VEGF protein expression. Prominent suppression of VEGF/VPF expression in vivo, as well as a significant reduction in tumor blood vessel counts, were also observed in established A431 tumors shortly after injection of the antibody as few as four times into nude mice. Transformation of NIH 3T3 fibroblasts with mutant ErbB2/neu, another EGFR-like oncogenic tyrosine kinase, resulted in a significant induction of VEGF/VPF, and the magnitude of this effect was further elevated by hypoxia. Moreover, treatment of ErbB2/neu-positive SKBR-3 human breast cancer cells in vitro with a specific neutralizing anti-ErbB2/neu monoclonal antibody (4D5) resulted in a dose-dependent reduction of VEGF/VPF protein expression. Taken together, the results suggest that oncogenic properties of EGFR and ErbB2/neu may, at least in part, be mediated by stimulation of tumor angiogenesis by up-regulating potent angiogenesis growth factors such as VEGF/VPF. These genetic changes may cooperate with epigenetic/environmental effects such as hypoxia to maximally stimulate VEGF/VPF expression. Therapeutic disruption of EGFR or ErbB2/neu protein function in vivo may therefore result in partial suppression of angiogenesis, a feature that could enhance the therapeutic index of such agents in vivo and endow them with anti-tumor effects, the magnitude of which may be out of proportion with their observed cytostatic effects in monolayer tissue culture.

Adenocarcinoma↗
PubMed1997

[Superoxide inhalation as adjuvant therapy in children with bronchial asthma].

The aim of the present investigation was to confirm results of an earlier pilot study on the adjuvant treatment of atopic asthmatics using superoxide inhalation in a double blind placebo controlled experiment. Group 1 (verum) included 28 patients (7 girls and 21 boys whose age was 12.2c2.9 years) and Group 2 (placebo) comprised 23 (8 girls and 15 boys aged 11.7c3.2 years). Fifteen-minute superoxide inhalations were used as adjuvant therapy to the routine treatment. The patients underwent spirometry, blood analysis, nasal smear tests for eosinophils, and questionnaires. The worse the baseline parameters were, the better their spirometric ones were. This was reflected by higher significant correlations between the baseline values and their changes in peak flowmetry, FEV1, and FEF and by the patients' grouping by the baseline limitation of respiratory functions (less than 80% or more of the individual normal values). The most significant improvement (46.5%; p = 0.008) was observed in the subgroup with VC. In accordance with subjective assessment data, the time course of reductions in the frequency and severity of asthma attacks and coughing fits, and sputum amount was significantly better in Group 1 than in Group 2. The findings are interpreted as a result of an alleviated inflammatory process due to superoxide inhalation-induced oxidative training in patients.

Administration, Inhalation↗
PubMed1996

Exogenous gaseous superoxide potentiates the antinociceptive effect of opioid analgesic agents.

The study examined the potentiation of the antinociceptive action of opioid analgesics produced by gaseous superoxide (GS) in the rat hind paw withdrawal test (PWT) and by GS or hydrogen peroxide (HP) in the formalin test. In the PWT, inhalation of GS for 50 minutes before i.p. injection of threshold doses of morphine (0.5 mg/kg) and trimeperidine (1.0 mg/kg) increased the threshold of nociception (TN) by a maximum of 43.0% (p < 0.05) and 113.4% (p < 0.01) respectively. The GS/trimeperidine-dependent increase in TN showed two peaks, the second of which could be suppressed by nialamide. Naloxone abolished the GS/ morphine-dependent increased in the TN. In the formalin test, a significant antinociceptive effect developed after GS inhalation or HP administration (intranasally, 2 x 5 microliters of 2 x 10(-5) mol/l solution in saline) in combination with low doses of Omnopon (0.06-0.75 mg/kg). These results suggest that both GS and HP potentiate the antinociceptive effects of opioid analgesics.

Analgesics, Opioid↗