Biomedical subjects

R L Goodman

Publications and source records attributed to R L Goodman.

At least 55 records · Page 3Linked to original sources

PubMed1991

Hypothalamic sites of catecholamine inhibition of luteinizing hormone in the anestrous ewe.

Norepinephrine (NE) and dopamine (DA) actively inhibit the release of LH in anestrous ewes. This can be detected as an increase in LH pulse frequency following i.v. injection of NE and DA antagonists. The objective of this study was to determine the sites of these inhibitory actions in the ovine hypothalamus by using local administrations of the NE antagonist, phenoxybenzamine (PBZ), or the DA antagonist, pimozide (PIM), into specific hypothalamic areas. Each neurotransmitter antagonist was administered via a chronically implanted steel guide tube into either the preoptic area (POA), retrochiasmatic area (RCh), or the median eminence region (ME). Blood samples were taken every 15 min for 2 h before and 4 h during implantation of these drugs and were analyzed for LH and prolactin by RIA. Control (no treatment) samples were obtained similarly from the same animals on another day. Placement of PBZ into the POA significantly increased LH pulse frequency and mean LH concentrations over control values whereas PIM did not. In contrast, PIM significantly increased LH pulse frequency and mean LH concentrations when placed in the ME or in the RCh, but PBZ did not. No effects of PIM on prolactin concentrations were detected. These results suggest that an NE neural system operates in the POA and that a DA system acts in the medial basal hypothalamus (RCh or ME) to suppress GnRH pulse frequency in the ovary-intact anestrous ewe.

Anestrus↗

PubMed1991

Patterns of circulating gonadotropins and ovarian steroids during the first periovulatory period in the developing sheep.

This report provides evidence that an increment in serum gonadotropin levels occurs at puberty in the sheep and that this reflects the critical hormonal event culminating in first ovulation in this species. Blood samples were collected from 6 female lambs at 4-h intervals for a period of approximately 2 mo around the expected time of puberty (32 wk of age) until behavioral estrus was observed and ovulation was verified by assay of serum progesterone. Patterns of circulating LH, FSH, progesterone, and estradiol concentrations were characterized during the peripubertal period for each lamb. A rise in serum levels of both LH and FSH began approximately 7-10 days before the first preovulatory surge of gonadotropins. Although the increase in gonadotropin levels occurred gradually over several days, serum estradiol levels rose only during the final 40-60 h prior to the preovulatory surge of gonadotropin. Serum progesterone profiles revealed, however, that normal (14-16-day) luteal phases were induced in only 2 of 6 females as a result of the first surge. In four lambs, a short luteal phase of 2.5 days' duration occurred, which was followed by another estradiol rise and a preovulatory surge that then resulted in a full luteal phase of 14 days' duration. These data demonstrate clearly that the precipitating event at puberty in the female sheep is an increase in circulating gonadotropin levels and that the estradiol secreted from the newly stimulated follicle provides the signal for the first preovulatory surge.

Animals↗

PubMed1991

Endogenous opioid suppression of luteinizing hormone pulse frequency and amplitude in the ewe: hypothalamic sites of action.

Evidence suggests that endogenous opioid peptides (EOP) inhibit pulsatile luteinizing hormone (LH) secretion during both the luteal and follicular phases of the ovine estrous cycle. Further data from sheep and other species indicate that the hypothalamus is the primary site of action for this EOP inhibition. The purpose of the following experiments was to determine which areas of the hypothalamus are involved in the EOP inhibition of pulsatile LH secretion. Regularly cycling ewes (n = 10) were stereotaxically implanted with guide tubes into the preoptic area (POA) and medial basal hypothalamus (MBH). Implants containing the EOP antagonist WIN 44,441-3 (WIN) were placed into each of these areas. Blood samples were collected at 12-min intervals for 3 h before and during WIN administration in the luteal phase and for 4 h before and during WIN administration in the follicular phase of the estrous cycle. During the luteal phase, WIN implants in either area increased (p less than 0.01) LH pulse frequency (POA 1.4 +/- 0.3/3 h before vs. 3.1 +/- 0.4/3 h during; MBH 1.1 +/- 0.2/3 h before vs. 2.8 +/- 0.5/3 h during). There was no effect on LH pulse amplitude. In contrast, during the follicular phase, WIN implants selectively increased (p less than 0.01) LH pulse frequency when implanted in the POA (3.2 +/- 0.4/4 h before vs. 5.2 +/- 0.6/4 h during) while increasing (p less than 0.05) only LH pulse amplitude when placed in the MBH (0.7 +/- 0.2 ng/ml before vs. 1.4 +/- 0.3 ng/ml during).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1990

The detection of local recurrence after definitive irradiation for early stage carcinoma of the breast. An analysis of the results of breast biopsies performed in previously irradiated breasts.

One hundred forty-five breast biopsies were performed in 139 treated breasts to evaluate for potential recurrent carcinoma of the breast in women previously treated with definitive breast irradiation for early stage carcinoma of the breast. One hundred thirty-four patients had undergone one breast biopsy, four patients had undergone two breast biopsies, and one patient had undergone three breast biopsies. The median interval from completion of definitive irradiation to breast biopsy was 28 months (range, 2 to 117 months). Of the 145 breast biopsies, 52% (76 of 145) were positive, and 48% (69 of 145) were negative. The positive biopsy rate was related to the type of biopsy, the location of the biopsy, and the findings on physical examination and mammography. In patients with a negative physical examination but mammographic findings of a mass, microcalcifications, or both, the positive biopsy rate was 66% (25 of 38). For patients with a mass on physical examination but a negative mammogram, the positive biopsy rate was 28% (nine of 32). For patients with a mass on physical examination and a positive mammogram, the positive biopsy rate was 72% (13 of 18). For patients undergoing an incisional or Tru-Cut (Travenol Laboratories, Deerfield, IL) needle biopsy, the positive biopsy rates were 94% (15 of 16) and 75% (three of four), respectively, whereas the positive biopsy rate for an aspiration cytology was 25% (five of 20). Of the 76 positive biopsies, 64% (49 of 76) were from an in field or marginal location. The rate of detection of a subsequent local recurrence after an initial negative biopsy was 5% (three of 66). Of the evaluable patients, the complication rate was 9% (seven of 81). This study has documented the results of breast biopsies after definitive irradiation for early stage carcinoma of the breast.

Biopsy↗

PubMed1990

The impact of mammography on the patterns of patients referred for definitive breast irradiation.

To evaluate the impact of mammography on the patterns of patients referred for definitive breast irradiation, the records of 1507 cases of carcinoma of the breast in 1468 women treated between 1977 and 1988 with breast-conserving surgery and definitive irradiation were reviewed. All patients had undergone complete excision of the primary tumor with or without axillary staging. All patients had either noninvasive, intraductal carcinoma (American Joint Committee [AJC] Stage Tis, N0) or invasive carcinoma (AJC Stage T1 or T2, N0 or N1). The use of a mammographic needle localization breast biopsy for diagnosis of a nonpalpable carcinoma steadily increased over time from 3% (one of 32) in in 1977-78 to 26% (111/421) in 1987-88 (P less than 0.0001). The percentage of intraductal carcinomas was significantly increased for the cases in which a mammographic needle localization was used for biopsy of a nonpalpable carcinoma (P less than 0.0001). There was an increase in the incidence of intraductal carcinomas in patients referred for definitive breast irradiation over time from 6% (two of 32) in 1977-78 to 13% (53/421) in 1987-88 (P = 0.0004). These results demonstrate that the use of mammography has had a significant impact on the patterns of patients referred for breast conservation and definitive irradiation with an increase in the percentage of nonpalpable cancers diagnosed using mammographic needle localization and with an increase in the percentage of intraductal carcinomas referred over time.

Biopsy, Needle↗

PubMed1990

Breast recurrence following conservative surgery and radiation: patterns of failure, prognosis, and pathologic findings from mastectomy specimens with implications for treatment.

Between 1978 and 1986, 1030 women with clinical Stage I or II breast cancer underwent excisional biopsy, axillary dissection (948 patients), and definitive irradiation. Sixty-five patients developed a recurrence in the treated breast, 9 of which were associated with simultaneous (8) or antecedent (1) distant metastases. Detection was by mammography alone in 29%, physical exam alone in 50%, and both in 21%. The median interval to recurrence was 34 months. Overall, 65% of the recurrences were in the vicinity of the original tumor; however, as the interval to recurrence increased, the percentage of operable recurrences in a separate quadrant increased. For those recurring after 5 years, 54% were in a separate quadrant. Ninety-five percent of the recurrences unassociated with distant metastases were operable and pathology revealed non-invasive cancer only in 10%. Fifty-two patients underwent salvage mastectomy. Thirteen patients had no residual tumor following excisional biopsy at the time of mastectomy. None of the following factors were predictive for no residual tumor: initial age, method of detection, interval to recurrence, location of recurrence, or histology. Local-regional control following mastectomy was 95%. The 5-year actuarial overall and disease-free survivals for salvage mastectomy patients were 84% and 59%, respectively. The only significant prognostic factor for survival was the initial clinical tumor size, which was related to the extent of the recurrence. Based on the inability to identify factors which would predict for a localized recurrence pathologically, we recommend mastectomy as the preferred surgical treatment for an isolated breast recurrence. Adjuvant chemotherapy may be beneficial in patients with an unfavorable prognosis.

Adult↗

PubMed1990

Definitive irradiation for intraductal carcinoma of the breast.

During the period from 1978 to 1985, 51 women with intraductal carcinoma of the breast were treated with definitive irradiation following breast-conserving surgery. Surgical treatment of the primary tumor in all patients consisted of excisional biopsy or wide resection. In general, definitive irradiation consisted of conventional breast tangents to 4500-5000 cGy followed by a breast boost to a total dose of 6000-6600 cGy (median = 6000 cGy; range = 4200-6600 cGy). No patient was treated with radiation to a supraclavicular or axillary field. For the 51 patients, the median follow-up was 68 months (range = 25-126 months). The 5-year actuarial rate of local failure was 6%. A total of five patients failed in the breast at 19, 35, 40, 79, and 119 months following definitive irradiation. Salvage treatment in these five patients consisted of mastectomy in all five patients plus adjuvant tamoxifen in one patient. All five of the patients with breast failures are alive and NED (no evidence of disease), although with limited follow-up (median = 12 months; range = 6-68 months). These results suggest that definitive irradiation is an acceptable alternative to conventional mastectomy for appropriately selected and staged patients with intraductal carcinoma of the breast. In view of the long natural history of this disease, prolonged and careful follow-up of these patients is required.

Adult↗

PubMed1990

A nondivergent three field matching technique for breast irradiation.

Effective radiation therapy to intact breasts requires the delivery of adequate dose to a large target volume using complex beam arrangements. A semi-empirical method is described to determine the correct gantry, collimator, and couch positions for a geometrically accurate field match among adjoining radiation beams. The technique uses a metal rod and chain combination to aid determination of the proper couch setting under remote fluoroscopy control. A couch position error of more than half a degree is easily detectable by this technique.

Breast Neoplasms↗

PubMed1990

Psychological effects of breast-conserving cancer treatment and mastectomy.

Patients in the early stages of breast cancer were studied one year after treatment to ascertain the psychological effects of mastectomy and a breast-conserving alternative, lumpectomy plus radiation therapy. Patients who had had a mastectomy felt less attractive, less sexually desirable, and more ashamed of their breasts. They also experienced less enjoyment in their sexual relationships than they had before treatment. Patients who had radiation therapy experienced no changes in these areas. For these reasons, half of the mastectomy patients regretted not having chosen the breast-conserving alternative.

Body Image↗

PubMed1990

Further evidence that serotonin mediates the steroid-independent inhibition of luteinizing hormone secretion in anestrous ewes.

Two photoperiod-controlled neuroendocrine systems appear to suppress secretion of tonic luteinizing hormone (LH) in anestrous ewes: a steroid-independent system that decreases LH pulse frequency in ovariectomized ewes and a steroid-dependent system whereby estradiol gains the capacity to suppress LH pulse frequency in anestrus. This study was designed to test the hypothesis that serotonergic neurons inhibit LH pulse frequency in ovariectomized ewes and to examine the possible interaction of this system with the steroid-dependent inhibition of LH pulse frequency in the anestrous season. In Experiment 1, i.v. injection of serotonin receptor antagonist, methysergide, significantly increased LH pulse frequency in ovariectomized ewes during the anestrous season. In Experiment 2, we examined the effects of oral administration of parachlorophenylalanine for 5 days on the synthesis of serotonin. This treatment significantly increased LH pulse frequency in ovariectomized ewes, but had no effect on the negative feedback action of estradiol. These data support the hypothesis that a serotonergic neural system mediates the steroid-independent inhibition of LH pulse frequency in anestrous ewes and suggest that this system is not absolutely essential for the functioning of the steroid-dependent system responsible for the negative feedback action during the anestrous season.

Anestrus↗

PubMed1990

A role for catecholaminergic neurons in the suppression of pulsatile luteinizing hormone secretion in the prepubertal ewe lamb.

These experiments tested the hypothesis that inhibitory catecholaminergic neural systems suppress tonic luteinizing hormone (LH) secretion in the prepubertal ewe lamb, as they do in the adult anestrous ewe. This was done by determining the effects of the alpha-adrenergic antagonist, phenoxybenzamine, and the dopaminergic antagonist, pimozide. In the first experiment, pimozide at 0.24 mg/kg increased LH plus frequency in 28-week-old lambs, but not in 17-week-old animals. Phenoxybenzamine (0.8 mg/kg) had no effect at either age. In experiment 2, a dose-response curve for pimozide (0.008, 0.08, 0.8 mg/kg) and a high dose of phenoxybenzamine were tested at two ages. The highest dose of pimozide and phenoxybenzamine stimulated LH release at both 22 and 28 weeks, although the magnitude of the response was blunted in older lambs. In the third experiment, we tested whether age or time of year determined the response to pimozide by using two groups of lambs born 5 weeks apart. Two doses of pimozide (0.24 and 0.8 mg/kg) were tested at the same time of year in these lambs. The highest dose of pimozide again stimulated LH secretion in 22-week-old lambs, but not in 17-week-old animals; the lower dose produced a partial (not statistically significant) response only in older lambs. These data suggest that inhibitory catecholaminergic (probably dopaminergic) neurons contribute to the suppression of tonic LH secretion prior to puberty in the ewe lamb, but that this neural system only becomes functional between 17 and 22 weeks of age.

Animals↗

PubMed1990

Irradiation-related ischemic heart disease.

An expectation for long-term survival has emerged among several groups of cancer patients treated with therapeutic irradiation (eg, Hodgkin's disease, early stage breast cancer). Therefore, the cardiovascular sequelae of thoracic irradiation have recently come under scrutiny. Animal models have demonstrated that cardiac irradiation can directly damage the myocardial microvasculature and can indirectly damage the coronary macrovasculature when coupled with cholesterol feeding. A clear association between thoracic radiotherapy and ischemic heart disease was observed among older clinical studies using radiotherapeutic techniques that are no longer optimal by today's standards. Such a relationship could not be confirmed in modern studies in which treatment factors (such as dose and volume of heart irradiated) were more carefully controlled.

Animals↗

PubMed1990

Atypical hepatic vein leiomyoma extending into the right atrium: an unusual cause of the Budd-Chiari syndrome.

A 14-year-old male presented with a one week history of weakness, lightheadedness and vomiting. Bilateral pleural effusions were evident on chest radiography; electrocardiogram revealed decreased voltages. Echocardiogram, abdominal ultrasound and magnetic resonance imaging revealed a mass in an hepatic vein and the inferior vena cava extending up to and filling the right atrium. Under deep hypothermia and extracorporeal circulation the mass was removed en bloc. It originated from the hepatic vein. Pathology revealed a smooth muscle tumour intermediate between benign and malignant (atypical leiomyoma). This is the first reported pediatric primary leiomyoma of the hepatic vein. It caused the Budd-Chiari syndrome, a rare pediatric entity.

Actins↗

PubMed1989

Biopsy results of new calcifications in the postirradiated breast.

A breast biopsy was performed in 19 patients for the finding of new mammographic calcifications without an associated palpable or mammographic mass after breast-conserving surgery and definitive irradiation for early stage breast cancer. The interval postradiotherapy was 9 to 96 months with a median of 34 months. Eleven of the biopsy specimens (58%) were positive for recurrent breast cancer and eight (42%) were negative. The pathologic results from the positive biopsy specimens showed four with invasive ductal carcinoma, two with microinvasive ductal carcinoma, four with intraductal carcinoma, and one with lobular carcinoma in situ (LCIS). Treatment consisted of mastectomy in eight patients, mastectomy plus chemotherapy in one patient, and biopsy for the patient with LCIS. One patient refused a recommended mastectomy. All 11 patients with recurrent carcinoma are alive with no evidence of disease after salvage therapy, although follow-up is short (median, 14 months; range, 0-48 months). Calcifications which developed in a quadrant different from the initial tumor tended to be malignant with four of five having a positive biopsy result. Microcalcifications were not commonly associated with the initial tumor with only five of 19 having microcalcifications. These results show that the development of new calcifications in the postirradiated breast is associated with a positive biopsy rate of 58% and that the tumors which are found tend to be early and potentially salvageable. The positive biopsy rate of 58% in the postirradiated breast is in marked contrast to the lower positive biopsy rate for microcalcifications in the nonirradiated breast as reported in the literature.

Biopsy↗

PubMed1989

Frequency, sites of relapse, and outcome of regional node failures following conservative surgery and radiation for early breast cancer.

Between 1970 and 1986, 990 patients underwent excisional biopsy and radiation for clinical Stage I or II breast cancer. A limited axillary dissection (levels I and II) was performed in 914 of these patients. The median follow-up was 40 months from the initiation of radiation. Thirty-one patients developed a regional node failure as their first site of recurrence either with (12 patients) or without (19 patients) simultaneous distant metastases. The median interval to recurrence was 27 months (range 4-59). The 5-year actuarial rate for an isolated regional node recurrence (without simultaneous distant metastases) was 3%. The most common site for a regional node failure was the axilla (17 patients) followed by the supraclavicular nodes (13 patients). Salvage therapy was effective for an axillary +/- breast failure with 10/14 patients alive with no evidence of disease. Prognosis was related to the site of recurrence as well as the presence or absence of distant metastases. The 5-year actuarial survival from initial treatment for all patients with a regional node failure was 63% with a 3-year actuarial survival of 57% from diagnosis of recurrence. Regional node failure was related to the number of axillary nodes removed at the time of dissection and patient age.

Adult↗

PubMed1989

Age as a prognostic factor for patients treated with definitive irradiation for early stage breast cancer.

From 1977 to 1986, 88 breast cancers in 86 women age less than or equal to 35 years were treated with definitive irradiation following breast-conserving surgery. The records of these cases were reviewed and compared to 808 breast cancers in 798 women age greater than or equal to 36 years treated similarly during the same time period. All women had AJC clinical Stages I or II invasive carcinoma of the breast and had undergone an axillary surgical staging procedure to determine pathologic lymph node staging prior to receiving definitive radiotherapy. There was no statistical difference between the younger and older women in terms of 5-year actuarial overall survival (94% vs. 90%), NED survival (78% vs. 81%) or relapse-free survival (70% vs. 77%). Although the younger women tended to have an earlier pattern of failure, the difference between the actuarial percentage of failures at 5 years for the two age groups was not significantly different for local only first failure (9% vs. 5%), regional only first failure (6% vs. 3%), and local and regional only first failure (0% vs. 1%). Subset analyses also did not show a difference between the younger and older patients. Although longer follow-up will be needed to confirm these observations, our 5-year results show that younger patients less than or equal to age 35 do not have an adverse outcome in terms of survival, local control, or regional control when compared with older patients greater than or equal to age 36. Potential candidates for definitive irradiation following breast-conserving surgery should not be excluded for treatment solely on the basis of younger age less than or equal to 35 years.

Adult↗

PubMed1989

Bilateral breast carcinoma treated with definitive irradiation.

From 1977 to 1987, 30 women were treated with definitive irradiation following breast-conserving surgery for bilateral carcinoma of the breast for a total of 60 treated breasts. Eleven women presented with concurrent bilateral carcinoma, and 19 women had sequential bilateral carcinoma. Pathologic axillary staging was performed in 51 of the 60 treated breasts. A total dose of greater than or equal to 6,000 cGy was delivered from breast tangential irradiation plus an electron or Iridium boost to 95% (57/60) of the treated breasts. A third field was used to treat the regional axillary and supraclavicular lymph nodes bilaterally in three women (10%) and unilaterally in ten women (33%). Tangential fields were matched at midline in 17 patients, and in ten patients, the tangential fields overlapped by up to 3 cm on skin. In two patients, the tangential fields were matched to an internal mammary nodal field, and in one patient, tangential fields were matched to a mediastinal field given for postoperative radiotherapy for lung cancer. For the overall group of 30 patients, the 5-year actuarial NED survival following treatment of the first breast cancer was 79%, and the 5-year actuarial relapse-free survival was 72%. For the 60 treated breasts, the 5-year actuarial local failure rate was 6%. An analysis of complications and cosmesis showed results similar to previously reported results for unilateral breast cancer. These results show that definitive irradiation following breast-conserving surgery for patients with bilateral breast cancer can technically be delivered with low complication rates and with acceptable survival and local control rates. Definitive irradiation should be considered as an acceptable alternative treatment to bilateral mastectomy for appropriately selected patients with concurrent or sequential bilateral early stage carcinoma of the breast.

Adenocarcinoma↗

PubMed1989

Psychological factors in the choice of treatment for breast cancer.

For several years women with an early diagnosis of breast cancer have been able to choose between two equally effective treatments: modified radical mastectomy and the breast-conserving treatment of lumpectomy plus radiation therapy. This study investigated the psychological factors that become involved when a woman chooses between treatments. Many more anticipatory concerns about body image, disfigurement, femininity, and the ability (or inability) to handle emotionally a mastectomy were expressed by lumpectomy/radiation therapy patients than by mastectomy patients. Those lumpectomy-radiation therapy patients who chose the treatment against medical advice were also found to be more concerned than the others about treatment effects on sexuality.

Adaptation, Psychological↗