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Biomedical subjects

R Goldberg

Publications and source records attributed to R Goldberg.

At least 109 records · Page 6Linked to original sources

Effects of tryptophan and serotonin uptake inhibitors on behavior in male transgenic transforming growth factor alpha mice.

Our findings have implicated that transgenic male mice overexpressing human growth factor alpha (TGF alpha) exhibit lengthened immobility in the swim test and elevated levels of aggression in the resident-intruder test. Further, these animals have a reduced ratio between the metabolite of serotonin (5-HT), and 5-HT in the brain. The present study investigated whether pharmacological manipulations of serotonergic transmission affect the altered behavioral patterns of the male TGF alpha mice. For that purpose, we used tryptophan (0, 50 or 100 mg/kg), a precursor substance to 5-HT, and 5-HT uptake inhibitors, zimelidine (0, 12.5 or 25 mg/kg) and clomipramine (0, 10 or 20 mg/kg). Administration of tryptophan or zimelidine significantly shortened immobility in the swim test in the TGF alpha male mice. Tryptophan or clomipramine did not influence the male non-transgenic CD-1 mice, and zimelidine significantly lengthened their immobility. High levels of aggression were completely reversed by zimelidine or clomipramine in the transgenic male mice. Neither of these compounds altered behavior of the control mice in the resident-intruder test. Tryptophan failed to affect aggressive behavior in the TGF alpha or control male mice. These results suggest that TGF alpha may influence behavior by affecting the uptake of 5-HT in neurons.

Aggression↗

Gender differences in the treatment of patients with acute myocardial infarction. A multihospital, community-based perspective.

OBJECTIVE: As part of a community-wide study examining temporal trends in the incidence and survival rates of acute myocardial infarction, we examined differences between the sexes in overall utilization rates and changes over time, therein, of various therapies used in the management of acute myocardial infarction. DESIGN: Nonconcurrent prospective study. PATIENTS: Three thousand three hundred sixty-one men and 2119 women hospitalized with validated acute myocardial infarction in 16 hospitals in the Worcester, Mass, metropolitan area during 1975, 1978, 1981, 1984, 1986, 1988, and 1990. RESULTS: After controlling, by means of a logistic regression analysis, for a variety of patient-related factors that could affect physician prescribing patterns, women were significantly more likely to receive diuretics during hospitalization for acute myocardial infarction, whereas men were significantly more likely to receive antiplatelet agents, lidocaine, and other antiarrhythmic agents. No statistically significant differences were seen between men and women with regard to the use of anticoagulants, beta-blockers, calcium channel blockers, digoxin, nitrates, and thrombolytic agents. Marked increases over time (1975 through 1990) were seen in the use of anticoagulants, antiplatelet agents, beta-blockers, lidocaine, and nitrates in each of the sexes, while declines were seen in the use of digoxin and diuretics. Use of thrombolytic therapy increased between 1986 and 1990, whereas use of calcium channel blockers decreased over this period for both men and women. CONCLUSIONS: The results of this multihospital, population-based, observational study suggest that physician practice patterns in the pharmacologic treatment of men and women hospitalized with acute myocardial infarction are very similar.

Aged↗

Confirmation that the velo-cardio-facial syndrome is associated with haplo-insufficiency of genes at chromosome 22q11.

The velo-cardio-facial syndrome (VCFS) and DiGeorge sequence (DGS) have many similar phenotypic characteristics, suggesting that in some cases they share a common cause. DGS is known to be associated with monosomy for a region of chromosome 22q11, and DNA probes have been shown to detect these deletions even in patients with apparently normal chromosomes. Twelve patients with VCFS were examined and monosomy for a region of 22q11 was found in all patients. The DNA probes used in this study could not distinguish the VCFS locus and the DGS locus, indicating that the genes involved in these haploinsufficiencies are closely linked, and may be identical. The phenotypic variation of expression in VCFS and DGS may indicate that patients without the full spectrum of VCFS abnormalities but with some manifestations of the disorder may also have 22q11 deletions.

Abnormalities, Multiple↗

Velo-cardio-facial syndrome: a review of 120 patients.

A series of earlier reports has described the velo-cardio-facial syndrome (VCFS), a syndrome of multiple anomalies including cleft palate, heart malformations, facial characteristics, and learning disabilities. The patients reported previously were primarily ascertained from a craniofacial program at a large tertiary medical center. Recent reports, including a companion paper in this issue, suggest that this common syndrome of clefting is also a common syndrome of congenital heart defect (CHD) which is expressed as familial examples of DiGeorge sequence. Appreciation of more severely affected cases of VCFS and the detection of mild expressions have led to a broadening of the phenotypic spectrum of the syndrome. The purpose of this report is to describe the full spectrum of VCFS, including several new manifestations and to compare the VCFS phenotype with published cases of "familial DiGeorge sequence" which are now thought to represent examples of VCFS.

Abnormalities, Multiple↗

Variable phenotypes in velocardiofacial syndrome with chromosomal deletion.

Velocardiofacial syndrome (VCF) has overlapping features with DiGeorge sequence; both result from a developmental field defect and probably represent contiguous gene deletion syndromes. The association of chromosome 22q11 deletion with DiGeorge sequence led us to do molecular analysis of chromosome 22 in 18 patients with VCF, who ranged in age from 6 to 42 years. All 18 patients had monosomy for the chromosome region 22q11. Retrospectively, we correlated the presence of the deletion with various clinical findings: 100% had cleft palate, 67% the facial phenotype, 83% cardiac disease, 94% learning disabilities, 70% ophthalmologic findings, 50% short stature, 22% psychiatric disorders, and 17% hypocalcemia. Both severely phenotypically affected and mildly affected patients had the deletion. These findings stress the importance of continued surveillance of all patients with VCF for the many medical problems that may not be present at initial diagnosis. We conclude that the presence of the gene deletion does not predict the phenotypic expression in VCF. Further studies to characterize the size of the gene deletion may facilitate better prediction of the phenotype.

Abnormalities, Multiple↗

Evaluation and management of acute uvular edema.

Acute uvular edema is a potentially life-threatening condition with a variety of causes. Other upper airway structures, most notably the epiglottis, may also become involved, and complete or partial airway obstruction may ensue rapidly. An accurate diagnosis may be essential in establishing effective treatment.

Acute Disease↗

Reference accuracy in the emergency medicine literature.

STUDY OBJECTIVE: To determine the incidence and nature of errors in the citation and quotation of references contained in the emergency medicine literature. DESIGN: A retrospective analysis of a random sample of articles and references found in the three major emergency medicine journals. SETTING: A university/county hospital. METHODS: We examined single issues of three emergency medicine journals: Annals of Emergency Medicine, Journal of Emergency Medicine, and American Journal of Emergency Medicine. INTERVENTIONS: None. MEASUREMENTS: Four independent reviewers assessed 145 references from 46 referring authors for citational and quotational accuracy. MAIN RESULTS: Major and minor citation errors were found in 10.3% and 17.2% of reference listings, respectively. Qualitative quotational errors were found in 35.2% of references. Eighty-two percent of these errors were considered to be major. Quantitative quotational errors were found in 47% of references reviewed. Secondary rather than primary reference sources were used in 41.4% of references reviewed. CONCLUSION: This study demonstrates a substantial error rate in the citation and quotation of reference sources in the emergency medicine literature. In addition, verification of primary source material was not done by a large percentage of the authors reviewed. Recommendations for improving the accuracy of the emergency medicine literature are offered.

Bias↗

Effect of alcohol on elevated aggressive behavior in male transgenic TGF alpha mice.

The effect of alcohol on aggressive behavior was studied in the highly aggressive transgenic TGF alpha male mouse. In contrast to findings obtained in other aggressive animals, low and moderate doses of alcohol failed to reduce this behavior in the TGF alpha mice; only a high dose reduced aggression. The plasma levels of alcohol were similar in the TGF alpha mice and non-transgenic control mice. However, the loss of righting reflex following an alcohol administration was significantly lengthened in the TGF alpha mice. These results suggest that the male TGF alpha mice can be used to investigate the mechanisms determining the physiological sensitivity to alcohol. Furthermore, these mice represent the first animal model supporting the findings obtained in humans that alcohol maintains pathological aggression.

Aggression↗

Medical students' experiences with and perceptions of chronic illness prior to medical school.

Concerns have been expressed about the failure of the medical curriculum to address the health-care needs of the chronically ill. It has been shown in the literature that medical students develop cynicism and negative feelings towards chronic illness as they progress through their training, perhaps as a result of the attitudes and frustrations of their teachers. What has been inadequately addressed are the experiences with and perceptions about chronic illness that medical students have before entering medical school. Some recommendations are made for curriculum changes based on the findings reported.

Attitude to Health↗

Velo-cardio-facial syndrome associated with chromosome 22 deletions encompassing the DiGeorge locus.

The large clinical overlap between DiGeorge syndrome and velo-cardio-facial syndrome suggests an aetiological connection. DiGeorge syndrome is associated with microdeletions of chromosome 22q11 and is therefore likely to be caused by reduced dosage of genes within this region. We present preliminary data that velocardiofacial syndrome patients have similar chromosome deletions, a finding consistent with the hypothesis that these disorders represent part of a spectrum of abnormalities seen with monosomy for 22q11.

Abnormalities, Multiple↗

Local staging of prostate cancer by tumor volume, prostate-specific antigen, and transrectal ultrasound.

Conventional methods of staging prostate tumors are highly inaccurate. To improve clinical staging, prostate-specific antigen (PSA) levels (> 10 ng/mL), sonographic tumor volume (> 3 cc), maximum tumor diameter, length of capsular tumor abutment, and overall impression of capsular irregularity suggesting periprostatic tumor spread were assessed in 29 men prior to undergoing radical prostatectomy for clinically localized tumor. After surgery, 18 men had tumor confined to the prostate, while 11 men had histologic evidence of extracapsular disease. Analysis of the parameters measured showed these were the most helpful factors in predicting the presence of extracapsular disease. However, the positive and negative predictive values were only 70 to 90 percent. Therefore, the clinical usefulness of any one measurement alone in determining treatment for the individual patient is limited. However, combining these parameters yields an improved prediction of extracapsular disease. All 6 patients with PSA < 10 ng/mL, tumor volume < 3 cc, and no capsular irregularity on ultrasound had localized disease (neg. predictive value = 100%), while all 7 patients who had more than one of these parameters had extracapsular disease (pos. predictive value = 100%). Thus, using the factors in combination may provide more accurate staging and thereby help in counseling patients regarding therapy.

Humans↗

Malignant melanoma of the eyelid. A report of eight cases and a review of the literature.

BACKGROUND: Because of the relatively rare occurrence of malignant melanoma (MM) of the eyelid, prognostic factors in relation to survival in these patients have not been established. OBJECTIVE: Our purpose was to examine prognostic indicators in relation to survival in patients with MM of the eyelid. METHODS: All patients seen at UCLA Medical Center with MM of the eyelid as well as all cases reported in the literature were reviewed retrospectively. RESULTS: The data obtained from 47 total cases seen at UCLA Medical Center revealed a significant disadvantage in 5-year survival for those patients with MM involving the lid margins in comparison to those without lid margin involvement. CONCLUSION: Our review suggests that melanoma involving the eyelid margin and conjunctiva has a worse prognosis than melanomas of the eyelid that do not involve the conjunctiva. We can make no predictions in regard to the benefits of narrow versus wide surgical margins in the treatment of these patients.

Adult↗

Processes of change in smoking cessation: a cross-validation study in cardiac patients.

The processes of change associated with smoking cessation were examined for 213 smokers and recent exsmokers who were scheduled for cardiac catheterization and compared to the processes reported by a sample of 180 nonmedical smokers and exsmokers. Subjects were classified into one of three stages of change depending on their readiness to quit smoking: precontemplation, contemplation, and action. The cardiac sample employed the processes of change more frequently than the nonmedical sample in all stages, but the functional relationship between the stages and processes of change was generally similar for the two groups. The hierarchical structure of the processes of change also was similar for both groups. Differences between the two samples in the use of the processes of change are discussed. These results are the first to support the validity of the stages and processes-of-change model of smoking cessation in a population experiencing severe illness.

Adult↗

Smoking cessation and severity of disease: the Coronary Artery Smoking Intervention Study.

We tested the effectiveness of an individually delivered behavioral multicomponent smoking intervention (SI) against offering advice only (AO) to 267 patients after coronary arteriography. After 6 months, 51% of AO patients and 62% of SI patients reported abstinence. Validated rates were 34% and 45% for AO and SI patients, respectively. Logistic regression analyses, controlling for severity of illness, stage of change, and self-efficacy, among other variables, showed that, at 6 months, the SI had the most effect for patients with more severe coronary artery disease (CAD) who had been admitted with a myocardial infarction (95% confidence interval = 2.05, 124.85). At 12 months, only severity of disease mediated SI effects (95% confidence interval = 3.10, 58.00). Similar results were seen for cotinine-validated cessation. This study confirms the effectiveness of individually administered SI for more seriously ill patients with CAD and raises questions as to how to better intervene with those individuals with less severe disease.

Attitude to Health↗

A biodegradable testosterone microcapsule formulation provides uniform eugonadal levels of testosterone for 10-11 weeks in hypogonadal men.

Limitations of presently available testosterone esters (enanthate and cypionate) include the fluctuating serum testosterone levels and the need for relatively frequent injections (every 10-21 days). These limitations of testosterone esters have prompted the development of more physiological and longer acting systems for androgen delivery. This paper reports pharmacokinetic and pharmacodynamic data with a second generation long-acting testosterone microcapsule formulation in hypogonadal men. This was a single dose, open label, nonrandomized study. Ten hypogonadal men with primary (n = 6) or secondary (n = 4) hypogonadism, otherwise in good health, received 630 mg microencapsulated testosterone in dextran solution (IM) on day 1. Serum total and free testosterone; LH; FSH; dihydrotesterone; estradiol; sex hormone-binding globulin; total cholesterol; high, low, and very low density lipoprotein cholesterol; triglycerides; and apoprotein-AII and -B were measured on multiple occasions during the 2-week control period and the 16-week treatment period. In addition, on days 0, 1, 28, 56, and 84, subjects were hospitalized for detailed hormone analyses over the 24-h period. Serum total and free testosterone levels rose quickly into the midnormal range and stayed uniformly in the eugonadal range for about 70-77 days, after which serum testosterone levels declined gradually into the hypogonadal range. Testosterone release from the microcapsule formulation over the first 10 weeks approximated zero order kinetics. Serum dihydrotestosterone levels rose into the normal range, and testosterone to dihydrotestosterone ratios remained in the physiological range. Serum estradiol levels rose and stayed in the midnormal male range. Serum sex hormone-binding globulin levels decreased significantly during treatment. Serum LH and FSH levels also significantly decreased in the six hypergonadotropic men. Total cholesterol low and very low density lipoprotein cholesterol and triglyceride levels did not change, but plasma high density lipoprotein cholesterol levels decreased significantly during treatment. These data indicate that testosterone microcapsule formulation provides uniform eugonadal levels of testosterone for about 10 weeks. The long duration and zero order kinetics make it an attractive alternative to existing methods of androgen replacement.

Adolescent↗

Large cell calcifying Sertoli cell tumor of the testis.

We report on a patient with a large cell calcifying Sertoli cell tumor of the testis and review the literature of this recently described rare subtype of Sertoli cell tumor. Twenty-one cases, including ours, have been reported in the literature. Six of twenty cases (28%) had clinically evident endocrine abnormalities and eight of twenty-one cases (38%) were bilateral. This tumor has a low malignant potential with only one patient known to have metastatic disease.

Calcinosis↗