Search PubMed⌕ Search

Biomedical subjects

R B Goldstein

Publications and source records attributed to R B Goldstein.

At least 91 records · Page 5Linked to original sources
PubMed1993

The role of velamentous cord insertion in the etiology of twin-twin transfusion syndrome.

OBJECTIVE: To evaluate the prevalence of velamentous cord insertion in twin-twin transfusion using the hypothesis that such insertions may contribute to the etiology of the condition. METHODS: All cases of placentas referred for pathologic evaluation at the University of California at San Francisco from 1984-1992 were reviewed for the citation of diamniotic-monochorionic placentation, including the presence of velamentous cord insertions. Maternal and infant records were studied for findings consistent with twin-twin transfusion syndrome. RESULTS: Thirty-eight cases of monochorionic-diamniotic twins were identified, 11 of which showed twin-twin transfusion syndrome. The prevalence of velamentous cord insertion in the transfusion syndrome subset was 63.6%, compared with 18.5% in those without (significant difference at P < .01). Twin-twin transfusion syndrome pregnancies with velamentous insertions were delivered at a significantly earlier gestational age; they also had fewer surviving infants and were more likely to have been treated prenatally than transfusion syndrome pregnancies without velamentous insertion, although these latter two findings were not significantly different. CONCLUSIONS: Velamentous cord insertions are more common in twin-twin transfusion syndrome pregnancies and may contribute to the development of profound disparity in fluid volume because the membranously inserted cord can be easily compressed, reducing blood flow to one twin. Large-volume amniocentesis may reduce this compressive force on the cord insertion, thus explaining the success of this mode of intervention.

Female↗
PubMed1992

A family study of obsessive-compulsive disorder.

First-degree relatives of probands with obsessive-compulsive disorder (OCD) (n = 32) and psychiatrically normal controls (n = 33) were blindly interviewed with the use of the Diagnostic Interview Schedule. The morbidity risk for anxiety disorders was increased among the relatives of obsessional subjects compared with that for the relatives of controls, but the risk for OCD was not. Risk for a more broadly defined OCD (including relatives with obsessions and compulsions not meeting criteria for OCD) was increased among the parents of obsessional subjects but not among the parents of controls (16% vs 3%). The findings suggest that an anxiety disorder diathesis is transmitted in families with OCD, but that its expression within these families is variable. The findings also support the current practice of classifying OCD as an anxiety disorder.

Adolescent↗
PubMed1992

Depression and other mental disorders in the relatives of morbidly obese patients.

The authors systematically interviewed 88 bariatric clinic patients presenting for vertical banded gastroplasty. The typical subject was middle-aged, female and of low socioeconomic status as indicated by his or her method of payment. Morbidly obese subjects were more likely than a comparison group to have first-degree relatives with a history of depression, bipolar disorder, antisocial personality, and other psychiatric disorders. These data indicate that relatives of morbidly obese subjects are frequently emotionally disturbed. Reasons for the findings are discussed.

Adult↗
PubMed1992

Prenatally detected myelomeningoceles: sonographic accuracy in estimation of the spinal level.

The sonograms and case records of 53 patients with prenatally detected myelomeningoceles were retrospectively reviewed. Sonographic findings were correlated with pathologic, surgical, and/or radiographic findings in 28 cases. Fourteen mothers chose to continue their pregnancies, and the level of neuromotor deficit was available for 11 children of this group. The sonographic and pathologic levels were in agreement in 18 of 28 cases (64%) and were within one spinal level in 22 of 28 cases (79%). The pathologic level of the lesion was underestimated (sonographic level lower than pathologic) in three fetuses and overestimated (sonographic level higher than pathologic) in another three. In 10 of 11 living children (91%) the neuromotor level was equal to or better than the anatomic level. The authors conclude that ultrasonography can, in most cases, allow accurate prediction of the level of the spina bifida lesion and the severity of neuromotor handicap in children with prenatal diagnoses of myelomeningocele.

Female↗
PubMed1992

Prevalence of mental disorder in 88 morbidly obese bariatric clinic patients.

OBJECTIVE: The authors sought to determine the association between mental disorder and morbid obesity, defined as weight at least 100% or 100 lb over ideal body weight. METHOD: Eighty-eight morbidly obese subjects who had come to a tertiary care center surgery clinic requesting vertical banded gastroplasty were systematically interviewed with the National Institute of Mental Health Diagnostic Interview Schedule (DIS) and the Structured Interview for DSM-III Personality Disorders. A comparison group of 76 psychiatrically normal subjects who were matched in age (within 5 years) and gender to the morbidly obese subjects were also interviewed. RESULTS: Most of the morbidly obese subjects were women, were of low socioeconomic status as indicated by method of payment for medical care, weighed more than 300 lb, and had been obese for more than 14 years. The morbidly obese subjects were more likely than the comparison group to have a lifetime history of mood disorders, anxiety disorders, bulimia, and tobacco dependence. The morbidly obese subjects were also more likely to meet diagnostic criteria for one or more personality disorders. CONCLUSIONS: Substantial psychopathology exists in morbidly obese individuals requesting gastroplasty, a finding that has important clinical implications.

Comorbidity↗
PubMed1992

Correlation between omphalocele contents and karyotypic abnormalities: sonographic study in 37 cases.

To evaluate the observation that fetuses with omphaloceles containing only bowel have an especially high prevalence of karyotypic abnormalities, we retrospectively reviewed the sonograms and case records of 37 fetuses with omphaloceles detected sonographically between 1984 and 1990. Nine fetuses had concomitant morphologic abnormalities characteristic of the amniotic band syndrome. Of the remaining 28 fetuses, karyotypic correlation was available in 22, and the karyotype was abnormal in five of these (23%). The omphaloceles contained liver in 22 fetuses and only bowel in six fetuses. Among fetuses with exteriorized liver, karyotypes were abnormal in one (6%) of 16 tested. In contrast, four (67%) of the six fetuses whose omphaloceles contained only bowel had abnormal karyotypes; for each of these four, sonograms showed morphologic abnormalities in addition to the omphalocele. In the two fetuses with bowel-only omphaloceles and normal karyotypes, the omphalocele was the only abnormality seen on sonograms, and these children are well after surgical repair. When fetuses with the amniotic band syndrome were excluded, sonograms showed concomitant anomalies in 15 fetuses with liver-containing omphaloceles, and the karyotype was abnormal in only one of these 15. The results of this study support previous observations that karyotypic abnormalities are more common in association with omphaloceles that contain only bowel compared with those that contain only liver. If we combine our data with data from three other studies that address this issue, 87% of fetuses with omphaloceles containing only bowel had an abnormal karyotype, a significantly higher rate than in those fetuses whose omphaloceles contained liver also (9%).

Amniotic Band Syndrome↗
PubMed1991

The prediction of suicide. Sensitivity, specificity, and predictive value of a multivariate model applied to suicide among 1906 patients with affective disorders.

Stepwise multiple logistic regression was utilized in an attempt to develop a statistical model that would predict suicide in a group of 1906 Iowans with affective disorders admitted to a tertiary care hospital. The risk factors identified by this approach included the number of prior suicide attempts, suicidal ideation on admission, bipolar affective disorder (manic or mixed type), gender, outcome at discharge, and unipolar depressive disorder in individuals with a family history of mania. However, the model failed to identify any of the patients who committed suicide. The results appear to support the contention that, based on present knowledge, it is not possible to predict suicide, even among a high-risk group of inpatients.

Adult↗
PubMed1991

The prediction of recovery using a multivariate model in 1471 depressed inpatients.

Stepwise multiple logistic regression was used in an attempt to develop a statistical model which would predict "recovery" in a group of 1471 depressives admitted to a tertiary care hospital. Six variables identified by this approach included: Electroconvulsive therapy, personality disorder, chronicity, anxiety disorder, organic mental disorder, and dysthymia. The meaning and significance of the findings are discussed.

Adult↗
PubMed1991

Fetal cephaloceles: diagnosis with US.

The prenatal sonograms of 15 fetuses with cephaloceles (13 occipital, one ethmoidal, and one frontoparietal) were retrospectively reviewed. The prognosis for fetuses with cephaloceles was poor: Only three of 14 with follow-up were born alive (21%), and all are likely to be handicapped. Karyotypes were abnormal in four of nine fetuses tested (44%). Associated cranial abnormalities observed in various numbers of fetuses included ventriculomegaly, the "lemon" sign, a flat basioccipital, "beaked" tectum, and bone defect. A wide variety of neural and nonneural anomalies were associated with cephaloceles. At least one sonographically observed concomitant neural or nonneural axis abnormality or an abnormal karyotype was present in nine of 15 fetuses (60%). Some associated neural malformations noted pathologically were not observed prenatally. Cranial meningoceles were not accurately distinguished from encephaloceles sonographically, and they also were associated with a poor prognosis. Comparison of findings in fetuses with cephaloceles with those of 15 fetuses with cystic hygromas revealed that the two abnormalities can usually be distinguished by the relationship of the mass with the neck and by other cranial findings present in fetuses with cephaloceles but absent in association with cystic hygromas.

Abnormalities, Multiple↗
PubMed1991

Image invariance with changes in size: the role of peripheral contrast thresholds.

The appearance of objects generally does not change with changes in the size of their retinal image that occur as the distance from the observer increases or decreases. Contrast constancy ensures this invariance for suprathreshold image features, but fully robust size invariance also requires invariance at threshold, so that near-threshold image features do not appear or disappear with distance changes. Since the angular size and the eccentricity of image features covary with distance changes, the threshold requirement for invariance could be satisfied approximately if contrast thresholds were to vary as the product of the spatial frequency and the eccentricity from the fovea. This model fits contrast thresholds for orientation identification over spatial frequencies of 1-16 cycles/deg and for retinal eccentricities of as much as 23 deg. Contrast detection thresholds from six different studies conform to this model over an even wider range of spatial frequencies and retinal eccentricities. The fitting variable, the fundamental eccentricity constant, was similar for all three studies that measured detection along the horizontal meridian and was higher for the orientation identification contrast thresholds along the same meridian. The eccentricity constant from studies that measured detection along the vertical meridian was higher than the constant calculated for the horizontal meridian and lower than the eccentricity constant for chromatic isoluminance gratings. Our model and these results provide new tools for analyzing the visibility of displays and for designing equal-visibility or variable-visibility displays.

Contrast Sensitivity↗
PubMed1991

Effect of measurement errors on sonographic evaluation of ventriculomegaly.

Ventriculomegaly is a sensitive indicator of maldevelopment of the fetal brain and spinal cord. The fetal ventricular atrium is an optimal portion of the lateral ventricular system to measure in order to judge ventriculomegaly. We tested the susceptibility of this measurement to inaccuracies created by errors in cursor placement or improper selection of the plane of section for measurement in 52 normal fetuses. This measurement was shown to be reasonably insensitive to errors in cursor placement along the axis of the ventricular system. However, choice of an off-axis image plane of section, an angled measurement, or improper choice of ventricular boundary leads to a relatively large number of false-positive test results (approximately 10%). None of the simulated errors in atrial measurements underestimates the size of the ventricle, and thus, they are unlikely to result in a diminution of test sensitivity.

Central Nervous System↗
PubMed1991

Image enhancement for the visually impaired. Simulations and experimental results.

Digital image enhancement has been proposed as an aid for the visually impaired. The capability of two enhancement techniques to improve recognition of images by patients with central scotoma or cataracts was evaluated using image-processing simulations and direct patient testing. Enhancements and simulations were based on measurements of contrast sensitivity loss for patients with macular disease. Contrast sensitivity loss was measured using Gabor-type localized stimuli and paradigms that are appropriate for analyzing form perception. The simulations using the contrast sensitivity data suggested that patients with moderate visual loss (20/70-20/200) may have difficulty recognizing faces and may benefit from enhancement by both of the techniques used. Ability to recognize celebrities from enhanced images improved for 39 of the 46 patients tested. The improvement was significant (P less than 0.05) for 16 of the 38 patients with central visual loss and for 3 of 8 patients with anterior segment media opacities tested. The simulations suggest that the benefits of image enhancement may be similar or even greater for recognition of other types of images.

Adult↗
PubMed1990

Environmental illness. A controlled study of 26 subjects with '20th century disease'.

Environmental illness is a polysymptomatic disorder believed by "clinical ecologists" to result from immune dysregulation brought on by common foods and chemicals. We systematically evaluated 26 subjects who had been assigned a diagnosis of environmental illness. The subjects indicated a strong interest in their diagnosis, were generally satisfied with their clinical ecologist, and were dissatisfied with traditional medical approaches. Subjects reported varying treatments, including dietary restrictions, avoidance of offending agents, and physical treatments. Using the Diagnostic Interview Schedule, we found that 15 (65%) of 23 subjects met criteria for a current or past mood, anxiety, or somatoform disorder compared with 13 (28%) of 46 age- and sex-matched community controls. We conclude that patients receiving this diagnosis may have one or more commonly recognized psychiatric disorders that could explain some or all of their symptoms.

Adult↗
PubMed1990

Fetal intervention in obstructive uropathy: prognostic indicators and efficacy of intervention.

Management of the fetus with bilateral hydronephrosis is controversial; ability to predict outcome and efficacy of prenatal intervention are unknown. We studied 40 fetuses referred for ultrasonography, examination of fetal urine, and possible therapy. We retrospectively assigned fetuses to a good prognosis group if fetal urine was hypotonic (sodium less than 100 mEq/L, chloride less than 90 mEq/L, osmolarity less than 210 mOsm/L) and there was no ultrasonographic evidence of dysplasia; we assigned fetuses to a poor prognosis group if even one criterion was abnormal. Survival was greater in the good prognosis group than in the poor prognosis group (81% vs 12.5%; 87% vs 30%, excluding abortions) (p less than 0.005). We then attempted to assess the efficacy of prenatal urinary decompression by comparing outcome within the good and poor prognosis groups. Survival with intervention was greater in both the good prognosis group and the poor prognosis group (89% vs 70% and 30% vs 0%). In 6 of the 8 survivors in the good prognosis group, severe oligohydramnios was reversed by decompression. We conclude the fetal urine electrolyte levels and ultrasonographic appear helpful in predicting residual fetal renal function and neonatal outcome and that prenatal decompression may prevent the development of fatal pulmonary hypoplasia.

Amniotic Fluid↗
PubMed1990

Correction of congenital diaphragmatic hernia in utero, V. Initial clinical experience.

Review of our experience with 45 cases of prenatally diagnosed congenital diaphragmatic hernia (CDH) confirms that most fetuses (77%) will not survive despite optimal pre- and postnatal care. Polyhydramnios, associated anomalies, early diagnosis, and a large volume of herniated viscera (including liver) are associated with a particularly dismal prognosis. After extensive experimental work demonstrated the efficacy, feasibility, and safety of repair in utero, we attempted to salvage six highly selected fetuses with severe CDH by open fetal surgery. Five had liver incarcerated in the chest: three died at operation because attempts to reduce the liver compromised umbilical venous return. In one, a Goretex diaphragm was constructed around the liver, but the baby died after birth. The last two fetuses, one with incarcerated liver, were successfully repaired. Both demonstrated rapid growth of the lung in utero, had surprisingly good lung function after birth despite prematurity, had the abdominal patch removed at 2 weeks, and subsequently died of nonpulmonary problems (an unrelated nursery accident in one and intestinal complications in the other). The only maternal complication was amniotic fluid leak and preterm labor. All six women are well and four have had subsequent normal children. From this phase I experience, we conclude that fetal surgery appears safe for the mother and her reproductive potential, that fetal CDH repair is feasible in selected cases, and that the fetal lung responds quickly after decompression. However, fetal repair remains a formidable technical challenge.

Adolescent↗
PubMed1990

Mild lateral cerebral ventricular dilatation in utero: clinical significance and prognosis.

The medical records of 55 fetuses with sonographically diagnosed mild ventriculomegaly (MVM) were reviewed to assess prognosis. Fetuses were divided into two groups based on the presence or absence of sonographically detected associated fetal anomalies: 13 had no other anomalies detected (isolated MVM), and 42 had concomitant neural axis and visceral anomalies (nonisolated MVM). Mortality was 83% among fetuses with nonisolated MVM and 38% among fetuses with isolated MVM (P less than .005). If terminated pregnancies are excluded, only one of nine (11%) fetuses with isolated MVM died, compared with nine of 16 (56%) fetuses with nonisolated MVM (P less than .005). There are 15 living children: Nine (60%) are developmentally normal at 6-30 months of follow-up (six had isolated MVM), three (20%) are or are likely to be abnormal, and we were unable to follow up three (20%). Fetal anomalies were missed in 11 of 30 (37%) fetuses with detailed follow-up. However, this would have changed the classification from isolated to nonisolated MVM in only one case. Thus, in 54 of 55 cases (or 29 of 30 cases with detailed follow-up), fetuses were accurately classified as having isolated or nonisolated MVM. The authors conclude that sonographically isolated MVM is associated with a significantly better prognosis than nonisolated MVM, and fetuses can be classified accurately based on prenatal sonograms.

Abnormalities, Multiple↗