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Biomedical subjects

S Goldberg

Publications and source records attributed to S Goldberg.

At least 73 records · Page 4Linked to original sources
PubMed1997

Treatment characteristics of congenital heart disease and behaviour problems of patients and healthy siblings.

OBJECTIVE: To examine behaviour problems of children in families where one child was diagnosed with congenital heart disease (CHD), in relation to the intensity of treatment required for the CHD. METHODOLOGY: Treatment intensity was based on patients' hospitalizations, surgical operations, current treatment, frequency of check-ups and finality of surgical repair. Mothers of 29 patients and 43 healthy siblings (4-14 years old), and a sub-sample of fathers, reported on behaviour problems of their children and rated the frequency of considering patient's CHD while performing routine child care in nine areas of family life (accommodation of illness). RESULTS: High treatment intensity was associated with high accommodation of illness and elevated behaviour problems among patients. In contrast, siblings in families where treatment intensity was low, but accommodation of illness high were at most risk for behaviour problems. CONCLUSIONS: Treatment intensity has a markedly different impact on behaviour problems of patients and healthy siblings. It is important for parents and healthcare professionals to provide both patients and siblings with information about the patient's medical condition, regardless how much treatment that condition may need.

Adolescent↗
PubMed1997

Isolation of Enterobacteriaceae from the mouth and potential association with malodor.

Bad breath is a common phenomenon, usually the result of bacterial metabolism in the oral cavity. It is generally accepted that Gram-negative bacteria are responsible for this problem, largely through degradation of proteinaceous substances. In initial experiments, screening of malodorous isolates following outgrowth of samples obtained from saliva, periodontal pockets, and the tongue dorsum yielded enterobacterial isolates. Clinical studies were conducted to examine the prevalence of such bacteria in four different populations: orthodontic patients, malodor clinic patients, complete-denture wearers, and a healthy young population. The prevalence of Enterobacteriaceae in the oral cavities of the denture-wearing population was very high (48.0%) as compared with the other groups: 27.1% in the malodor clinic patients, 16.4% in the normal population, and 13% among orthodontic patients. Isolates of Klebsiella and Enterobacter emitted foul odors in vitro which resembled bad breath, with concomitant production of volatile sulfides and cadaverine, both compounds related to bad breath. When incubated on a sterile denture, enterobacterial isolates produced typical denture foul odor. Isolates exhibited cell-surface hydrophobic properties when tested for adhesion to acryl and aggregation with ammonium sulphate. The results, taken together, suggest that Klebsiella and related Enterobacteriaceae may play a role in denture malodor.

Adolescent↗
PubMed1997

Reduction of oral malodor by oxidizing lozenges.

The main purpose of the study was to examine the anti-malodor properties of oxidizing lozenges, as compared to breath mints and chewing gum. Healthy, young adult volunteers (N = 123; mean age 24.5 years) were measured for oral malodor-related parameters (whole mouth odor measured by 2 judges; tongue dorsum posterior odor using the spoon test; volatile sulphide levels; salivary levels of cadaverine and putrescine; and 2 versions of an oral rinse test) on the first afternoon of the study. They were then assigned randomly to one of 6 groups (2 brands of breath mints, chewing gum with no active ingredients, regular and full-strength oxidizing lozenges, and a no-treatment control), and instructed to employ the treatment before bedtime, the next morning, and in the early afternoon 3 hours prior to measurements, which were carried out 24 hours following baseline measurements. Volunteers also estimated the level of their own whole mouth and tongue odors at baseline and post-treatment. The data showed that, among treatments, only the full-strength oxidizing lozenge significantly reduced tongue dorsum malodor, as determined by the spoon test. The full-strength lozenge also yielded a significant increase in the modified oral rinse test, presumably due, at least in part, to residual oxidizing activity retained in the oral cavity. Self-estimations of whole mouth and tongue malodor by volunteers were significantly correlated with corresponding-judge assessments, suggesting some degree of objectivity in assessing one's own oral malodor.

Administration, Oral↗
PubMed1997

The Varying Behavior of Stent Thrombosis in Native Coronary Arteries Versus Aorto-Coronary Saphenous Vein Bypass Grafts.

Out-of-lab closure due to stent thrombosis is a major limitation of stent implantation. In this report, the incidence of stent thrombosis in native coronary arteries is compared to saphenous vein bypass grafts. Elective stent placement was performed in 1,782 patients. Overall, stent thrombosis occurred in 64 (3.6%) of patients. There was a significantly higher incidence of stent thrombosis in native coronary arteries (56/1153, 4.9%) compared with venous bypass grafts (8/629, 1.3%), (p < 0.0001). Multivariate analysis demonstrated vessel size to be the most important predictor of stent thrombosis. We conclude that stent thrombosis occurs less frequently in vein bypass grafts and that the risk in the native circulation is inversely related to vessel size.

Journal Article↗
PubMed1996

Peripheral vascular complications after intracoronary stent placement: prevention by use of a pneumatic vascular compression device.

Peripheral vascular complications are a significant source of morbidity after coronary artery stent implantation. The goal of this study was to assess the incidence, risk factors, and management of vascular complications after stent placement. The study population consisted of 101 consecutive patients who underwent stent placement for either elective or bailout indications. All patients received a standardized anticoagulation regimen of aspirin, dipyridamole, low molecular weight dextran, heparin, and warfarin. Peripheral vascular access sites were examined daily until hospital discharge. Vascular complications occurred in 16 of 101 (16%) patients, including femoral artery pseudoaneurysm (n = 11), hematoma requiring transfusion or surgery (n = 4), and arteriovenous fistula (n = 1). Intervention was required in 14 of 16 (88%) patients with complications. These included transfusion (n = 7), ultrasound-guided compression (n = 8), and/or vascular surgery (n = 7). Length of hospital stay was prolonged in patients with complications (14 +/- 9 vs. 8 +/- 5 d, P < 0.001). The development of peripheral vascular complications did not correlate with clinical or procedural variables such as age, cardiovascular risk factors, arterial sheath size, or elective vs. bailout indication. After the introduction of a pneumatic vascular compression device (FEMOSTOP, C.A. Bard, Billerica, MA), a significant reduction in vascular complications was observed. Complications occurred in only 1 of 41 (2.4%) patients in whom the compression device was used in contrast to 13 of 58 (22.4%) patients compressed manually (P < 0.01). Thus peripheral vascular complications are frequent after coronary artery stent placement and are associated with serious morbidity and prolongation of hospital stay. These complications are significantly reduced by the use of a pneumatic vascular compression device despite intensive systemic anticoagulation.

Hemostasis, Surgical↗
PubMed1996

Adrenal suppression among asthmatic children receiving chronic therapy with inhaled corticosteroid with and without spacer device.

BACKGROUND: Inhaled corticosteroids have become a first-line treatment for chronic asthma. It has been shown that inhaled corticosteroids can have a measurable effect on the hypothalamic-pituitary-adrenal axis in asthmatic children. OBJECTIVE: To investigate the prevalence of adrenal suppression among asthmatic children receiving chronic therapy with low to moderate doses (up to 1000 micrograms) of inhaled beclomethasone dipropionate via a metered dose inhaler (MDI) and via MDI attached to a spacer device (MDI-spacer). METHODS: The study included 39 asthmatic children currently undergoing therapy; 24 received beclomethasone dipropionate by MDI attached to a spacer, and 15 directly by MDI. All the patients had been treated for at least 4 months. Another 21 children were normal controls. The 24-hour urinary free cortisol excretion was measured to evaluate hypothalamic-pituitary-adrenal axis function. RESULTS: Seven of 15 (47%) patients from the MDI group had reduced 24 hour-urinary free cortisol excretion and 2 of 24 (8%) in the MDI-spacer group (P = .006). The mean 24-hour urinary free cortisol excretion of the MDI group was 0.0185 +/- 0.0089 microgram/gram creatinine, and the MDI-spacer and the control groups were, 0.0290 +/- 0.0138 microgram/gram creatinine and 0.0270 +/- 0.0118 microgram/gram creatinine, respectively, (P = 0.37, f = 3.51 ANOVA). CONCLUSION: Chronic inhalation of low to moderate doses of corticosteroids is associated with adrenal suppression in some asthmatic children. This side effect is more common among patients inhaling directly from the MDI and is less frequent when a large volume spacer is attached to the MDI.

Administration, Inhalation↗
PubMed1996

Efficacy of a 2-phase oil: water mouthrinse in controlling oral malodor, gingivitis, and plaque.

The purpose of the study was to examine the anti-malodor, anti-gingivitis, and plaque reducing properties of a 2 phase oil:water mouthrinse compared with a control mouthrinse. Fifty subjects rinsed with one of the two rinses for 30 seconds twice a day over 6 weeks, while continuing their normal oral hygiene habits. Measurements were made at time zero (prior to beginning the rinsing regimen), and > or = 9 hours following rinsing, at intervals of 1, 3, and 6 weeks. Malodor of whole mouth, as well as tongue dorsum anterior and posterior, was assessed on a 0 to 5 semi-integer scale by two odor judges. Volatile sulphide compounds (VSC) were determined using a sulphide monitor. Gingival, plaque, and bleeding indices were recorded for Ramfjord teeth. Oral microbial levels were assessed using the oratest. Salivary levels of diamines (putrescine and cadaverine) were analyzed by HPLC. Results were analyzed by 2-tailed covariant ANOVA, with the time zero value as covariant. Dramatic improvements were observed in parameters associated with malodor, periodontal health, plaque accumulation, and microbial levels in both groups. As compared to time zero scores, whole mouth odor, tongue dorsum anterior and posterior odors decreased continuously over time, attaining 80%, 79% and 70%, reductions, respectively following 6 weeks, in the 2-phase mouthrinse group, versus 70%, 77% and 59% for the control group. For whole mouth and tongue dorsum posterior, the reductions observed in the 2-phase mouthrinse group were significantly greater than those obtained with the control mouthrinse (P = 0.026 and P = 0.025, respectively), suggesting that the 2-phase mouthrinse is superior to the control mouthrinse in long-term reduction of oral malodor. For bleeding index, gingival index, oral microbial levels, and VSC, differences between the groups were not significant. Diamine levels were not significantly reduced in either group. The control mouthrinse reduced plaque index more significantly than the 2-phase mouthrinse (P < 0.005). The results of this randomized clinical trial suggest that the 2-phase oil:water mouthrinse formulation is superior to the control mouthrinse in long-term reduction of oral malodor.

Adult↗
PubMed1995

Effect of thromboxane A2 blockade on clinical outcome and restenosis after successful coronary angioplasty. Multi-Hospital Eastern Atlantic Restenosis Trial (M-HEART II)

BACKGROUND: Antithromboxane therapy with aspirin reduces acute procedural complications of coronary angioplasty (PTCA) but has not been shown to prevent restenosis. The effect of chronic aspirin therapy on long-term clinical events after PTCA is unknown, and the utility of more specific antithromboxane agents is uncertain. The goal of this study was to assess the effects of aspirin (a nonselective inhibitor of thromboxane A2 synthesis) and sulotroban (a selective blocker of the thromboxane A2 receptor) on late clinical events and restenosis after PTCA. METHODS AND RESULTS: Patients (n = 752) were randomly assigned to aspirin (325 mg daily), sulotroban (800 mg QID), or placebo, started within 6 hours before PTCA and continued for 6 months. The primary outcome was clinical failure at 6 months after successful PTCA, defined as (1) death, (2) myocardial infarction, or (3) restenosis associated with recurrent angina or need for repeat revascularization. Neither active treatment differed significantly from placebo in the rate of angiographic restenosis: 39% (73 of 188) in the aspirin-assigned group, 53% (100 of 189) in the sulotroban group, and 43% (85 of 196) in the placebo group. In contrast, aspirin therapy significantly improved clinical outcome in comparison to placebo (P = .046) and sulotroban (P = .006). Clinical failure occurred in 30% (49 of 162) of the aspirin group, 44% (73 of 166) of the sulotroban group, and 41% (71 of 175) of the placebo group. Myocardial infarction was significantly reduced by antithromboxane therapy: 1.2% in the aspirin group, 1.8% in the sulotroban group, and 5.7% in the placebo group (P = .030). CONCLUSIONS: Thromboxane A2 blockade protects against late ischemic events after angioplasty even though angiographic restenosis is not significantly reduced. While both aspirin and sulotroban prevent the occurrence of myocardial infarction, overall clinical outcome appears superior for aspirin compared with sulotroban. Therefore, aspirin should be continued for at least 6 months after coronary angioplasty.

Angioplasty, Balloon, Coronary↗
PubMed1995

Influence of B2 receptor antagonists on bradykinin-induced vasodilation and edema formation in isolated rabbit hindlimbs.

In search of new possibilities to prevent acute inflammatory vascular reaction, we examined the effect of two selective B2 receptor antagonists, CP 0127 ([Bissuccimidohexane (L-Cys6)-1] and HOE 140 (D-Arg[Hyp3, Thi5, D-Tic7, Oic8]BK), on changes in perfusion pressure and on edema formation caused by bradykinin (BK) in the isolated perfused rabbit hindlimbs. CP 0127 and HOE 140 were added to the perfusion fluid 2 min prior to the first BK-administration (5 x 10(-9) mol/l). A second BK-stimulation was performed after 30 minutes. The antagonists were tested in groups of 6 experiments each at concentrations of 10(-6) mol/l, 5 x 10(-9) mol/l and 10(-10) mol/l. CP 0127 was also tested in a concentration of 10(-8) mol/l. The application of BK resulted in an acute decrease of the mean arterial pressure and in a continual edema formation, reflected by an increase of organ weight (controls, n = 6). Pretreatment with CP 0127 as well as with HOE 140 attenuated dose-dependently the BK-induced vasodilation (p < 0.005) and edema formation. The current results indicate that CP 0127 and HOE 140 are able to reduce BK-induced effects on vascular tone and edema formation.

Amino Acid Sequence↗
PubMed1995

Variability in lesion depth on prone and supine CT scans of the chest: implications for the accuracy of transthoracic needle aspiration biopsy.

Transthoracic needle biopsy of the lung is often performed fluoroscopically in the prone position; nodule depth measurements are made from accompanying computed tomographic (CT) scans performed supine. We evaluated the effect of prone and supine positioning on the effect of nodule depth as measured from the skin surface. Twenty consecutive patients having CT-guided biopsy performed in the prone position were assessed. Nodule depth from posterior skin surface to nodule was compared with prebiopsy supine CT scan. Nodules above the carina showed minimal change in depth. Those below the carina showed considerable variability, with depth changes < or = 4.0 cm. Awareness of the magnitude of the potential effect of patient position on lesion depth should be helpful in reducing the likelihood of false negative results in fluoroscopically guided biopsy.

Biopsy, Needle↗
PubMed1995

Sibling empathy and behavioural adjustment of children with chronic illness.

This study investigated the relationship of healthy siblings' empathy to the psychosocial adjustment of children with a congenital heart disease (CHD) in 28 sibling dyads aged 3.5-11 years, as well as the perceived quality of sibling interactions, reported by mothers and children with illness. As in previous studies, children with CHD were reported to have more behaviour problems in the clinical range than either siblings or normative populations. On the basis of a task unconnected with illness issues, siblings were assigned to a high or low empathy group. Children with illness, but not their mothers, saw the siblings with high empathy more positively than those with low empathy. However, the adjustment of the children with illness did not differ between high and low empathy groups. Findings suggest the need to seek children's points of view when studying psychosocial effects of paediatric conditions.

Adaptation, Psychological↗
PubMed1995

Behavioural inhibition, attachment and anxiety in children of mothers with anxiety disorders.

OBJECTIVE: This study examined the relationship between behavioural inhibition, insecure mother-child attachment and evidence of anxiety in the offspring of mothers with anxiety disorders. METHOD: Twenty children aged 18 to 59 months who were born to 18 mothers with diagnosed anxiety disorders were examined for behavioural inhibition (Kagan's measures) and mother-child attachment (Strange Situation Procedure). Child anxiety was assessed using DSM-III-R criteria and the Child Behavior Checklist (CBCL). RESULTS: Sixty-five percent of the children were behaviourally inhibited. They showed more somatic problems and fewer destructive behaviours than those who were not inhibited. Eighty percent of the children were insecurely attached. They had higher CBCL internalizing scores than secure children and three of them met diagnostic criteria for anxiety disorders. CONCLUSION: Though preliminary, this work suggests a need to identify children of anxious mothers as being at risk for anxiety, especially in the presence of inhibited temperament or attachment difficulties.

Anxiety Disorders↗