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Biomedical subjects

S Goldberg

Publications and source records attributed to S Goldberg.

306 records · Page 17Linked to original sources
PubMedDate not supplied

Prevention of a first stroke: a review of guidelines and a multidisciplinary consensus statement from the National Stroke Association.

OBJECTIVE: To establish, in a single resource, up-to-date recommendations for primary care physicians regarding prevention strategies for a first stroke. PARTICIPANTS: Members of the National Stroke Association's (NSA's) Stroke Prevention Advisory Board and Cedars-Sinai Health System Department of Health Services Research convened on April 9, 1998, in an open meeting. The conference attendees, selected to participate by the NSA, were recognized experts in neurology (9), cardiology (2), family practice (1), nursing (1), physician assistant practices (1), and health services research (2). EVIDENCE: A literature review was carried out by the Department of Health Services Research, Cedars-Sinai Health System, Los Angeles, Calif, using the MEDLINE database search for 1990 through April 1998 and updated in November 1998. English-language guidelines, statements, meta-analyses, and overviews on prevention of a first stroke were reviewed. CONSENSUS PROCESS: At the meeting, members of the advisory board identified 6 important stroke risk factors (hypertension, myocardial infarction [MI], atrial fibrillation, diabetes mellitus, blood lipids, asymptomatic carotid artery stenosis), and 4 lifestyle factors (cigarette smoking, alcohol use, physical activity, diet). CONCLUSIONS: Several interventions that modify well-documented and treatable cardiovascular and cerebrovascular risk factors can reduce the risk of a first stroke. Good evidence for direct stroke reduction exists for hypertension treatment; using warfarin for patients after MI who have atrial fibrillation, decreased left ventricular ejection fraction, or left ventricular thrombus; using 3-hydroxy-3 methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors for patients after MI; using warfarin for patients with atrial fibrillation and specific risk factors; and performing carotid endarterectomy for patients with stenosis of at least 60%. Observational studies support the role of modifying lifestyle-related risk factors (eg, smoking, alcohol use, physical activity, diet) in stroke prevention. Measures to help patients improve adherence are an important component of a stroke prevention plan.

Alcohol Drinking↗
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Does consumption of beer, alcohol, and bitter substances affect bitterness perception?

The relation between consumption of beer, alcohol, and bitter substances was investigated by comparing 20 each of male adults, low users ( < 720 ml/week) and high users ( > 3.61/week) of beer for sensitivity to and like/dislike for the bitterness of isohumulones. Intake of beer, alcohol, and bitter substances was measured with a food frequency questionnaire and a 14-day recall journal. Intake of alcohol (including alcohol from sources other than beer) and bitter substances was higher for high users of beer than for low users. The average bitterness units (BUs) in the beers consumed by the two groups did not differ, indicating that high users do not consume more bitter beers than low users. Detection thresholds for isohumulones in water did not differ between the two groups, but high users had higher difference thresholds for isohumulones in beer (p < 0.10). In time-intensity measurements of bitterness in beer, low users of beer recorded significantly higher maximum intensities (p < 0.001) and shorter total durations (p < 0.001) than high users, with no difference between the two groups for time to maximum intensity and area under the TI curve. There was no significant difference between the two groups for BUs of beers produced by ad lib mixing of low- and high-bitterness beers, or for mean hedonic ratings of various concentrations of isohumulones in beer. These results suggest that intakes of beer, alcohol, and bitter substances are not major determinants of taste responses to the bitterness of isohumulones.

Adult↗
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Central nervous system regeneration and ophthalmology.

Various adult lower vertebrates are capable of optic nerve, and even retinal, regeneration with functional recovery of vision. Possible factors responsible for regenerative failure in mammals are discussed. It is suggested that potentially neuroregenerative agents be tested in the mammalian retina in an attempt to induce visual pathway regeneration.

Animals↗
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Pneumothorax during fluoroscopic biopsy: effect on nodule depth.

Transthoracic needle aspiration biopsy of lung nodules is often performed under fluoroscopic guidance after measurement of lesion depth on preliminary computed tomography (CT) scans is obtained. We evaluated the change in depth of nodules in 10 patients in whom pneumothorax developed during CT-guided biopsy. We observed that nodule depth changed by an amount equal to the size of the pneumothorax. Awareness of the potential effect of pneumothorax on lesion depth should be helpful in reducing the likelihood of false-negative results with CT-assisted fluoroscopic biopsy when only single-plane fluoroscopy is available.

Biopsy, Needle↗
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Training for child day care staff and for licensing and regulatory personnel in the prevention of infectious disease transmission.

Recognition of the importance of preventing disease transmission in day care facilities has increased as more mothers of infants join the work force and as evidence of the spread of disease in day care mounts; the effectiveness of licensing agencies has eroded with the shrinking of resources, and limited compliance with current standards exists. Both the staff of child day care facilities and the personnel who are responsible for licensing and regulating such facilities require ongoing training in issues of health promotion and disease prevention. The curriculum of all training programs should include, in addition to child development, topics of general health and safety, such as safety hazards and the risk of infection, knowledge of the infectious diseases likely to be encountered in day care, the use of routine screening tests, the principles of good nutrition, the components of routine health assessment, and the special concerns of disabled, abused, and neglected children. Health professionals in the community and licensing personnel should function as channels for the dissemination of new information as it becomes available; inspection of facilities for the purpose of licensing provides an excellent opportunity for training staff. Monitoring has been found to heighten awareness and improve performance. Employees' compliance with regulations has been shown to increase when staff members are trained as advocates of health.

Child Day Care Centers↗
PubMedDate not supplied

VA Cooperative Study on Alcoholic Hepatitis. III: Changes in protein-calorie malnutrition associated with 30 days of hospitalization with and without enteral nutritional therapy.

Patients with moderate to severe alcoholic hepatitis and features of protein-calorie malnutrition were studied with respect to changes in their nutritional status during 30 days of hospitalization. Thirty-four patients served as controls, were given a 2500 kcal hospital diet and allowed to eat ad libitum. Twenty-three patients were given, in addition to the hospital diet, a nutrition supplement high in calories, protein, and branched-chain amino acids (Hepatic Aid). Because of anorexia, the controls consumed lesser amounts of both calories and protein while those given the nutritional therapy exceeded their estimated energy requirements (116.1%) and consumed a mean of 98.3 g of protein per day. This was well tolerated despite the fact that portal systemic encephalopathy was present in 72% of the patients. Mortality associated with the liver disease was comparable in both groups, 16.7% in the treated vs 20.6% in the controls. In those patients that survived the 30 days of hospitalization, clinical and biochemical tests of liver injury improved in both groups. With respect to their nutritional status, those given nutritional therapy showed significant improvement in six of the nine parameters (67%) used to assess nutrition. In the controls significant improvement was observed in only two nutritional parameters (22%) while three parameters (33%) deteriorated further. These three were all associated with calorie deprivation (marasmus). This study suggests that patients with acute alcoholic hepatitis require additional nutritional therapy to maintain and improve their nutrition parameters, especially those related to marasmus; and that Hepatic Aid is well tolerated for this purpose.

Adult↗
PubMedDate not supplied

Does postoperative irradiation play a role in the adjuvant therapy of stage T4 colon cancer?

PURPOSE: This study analyzes the long-term outcome of patients with stage T4 colon cancer who receive postoperative irradiation. The purpose of the study is to define the potential role of this modality with current systemic therapies. PATIENTS AND METHODS: A retrospective analysis was performed of 152 patients undergoing resection of T4 colon cancer followed by moderate- to high-dose postoperative tumor bed irradiation with and without 5-fluorouracil-based chemotherapy. Of the 152 patients, 110 patients (T4N0 or T4N+) were treated adjuvantly, whereas 42 patients received irradiation for the control of gross or microscopic residual local tumor. RESULTS: For 79 adjuvantly treated patients with stage T4N0 or T4N+ cancer with one lymph node metastasis, the 10-year actuarial rates of local control and recurrence-free survival were 88% and 58%, respectively. Results were less satisfactory for patients with more extensive nodal involvement. The 10-year actuarial rates of local control and recurrence-free survival of 39 patients with T4 tumors complicated by perforation or fistulas were 81% and 53%, respectively. For 42 patients with incompletely resected tumors, the 10-year actuarial recurrence-free survival was 19%. CONCLUSIONS: In comparison with historical controls, postoperative tumor bed irradiation improves local control for some subsets of patients. In addition to standard 5-fluorouracil-based chemotherapy, adjuvant tumor bed irradiation should be considered when colon cancers invade adjoining structures, when they are complicated by perforation or fistulas, or when they are incompletely excised at the primary site.

Adult↗
PubMedDate not supplied

The podiatric implications of giant cell tumors.

Giant cell tumors are benign neoplasms of unknown etiology that have a histologically distinctive, multinucleated giant cell tumor associated. Microscopic evaluation is essential for accurate diagnosis. The treatment of choice is total surgical excision.

Fibroblasts↗