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Biomedical subjects

S Goldman

Publications and source records attributed to S Goldman.

At least 127 records · Page 7Linked to original sources
PubMed1998

Myeloablative chemotherapy with autologous bone marrow rescue in young children with recurrent malignant brain tumors.

PURPOSE: This study evaluates the outcome of myeloablative chemotherapy and autologous bone marrow rescue (ABMR) with or without radiotherapy in children younger than 6 years of age with recurrent malignant brain tumors who had not previously been exposed to conventional fractionated external-beam irradiation. PATIENTS AND METHODS: Patients underwent surgery and/or conventional chemotherapy at the time of recurrence to achieve minimal residual disease (two of these patients also underwent local single-fraction gamma-knife radiosurgery). Myeloablative chemotherapy was then administered with carboplatin, thiotepa, and etoposide (16 patients), thiotepa and etoposide (three patients), or thiotepa, etoposide, and carmustine (BCNU; one patient). Autologous bone marrow was re-infused 72 hours after chemotherapy. Twelve patients received external-beam irradiation after recovery from ABMR. RESULTS: Twenty patients with recurrent brain tumors aged 0.7 to 5.9 years (median, 2.9 years) at ABMR were evaluated. Two patients died of toxicity related to myeloablative therapy. Eight patients died of progressive disease. Ten of 20 (50%) patients (primitive neuroectodermal tumor (PNET)/medulloblastoma, three patients; cerebral PNET, three patients; glioblastoma multiforme, two patients; anaplastic astrocytoma, one patient; pineal PNET, one patient) are alive and disease free at a median of 37.9 months (range, 9.7 to 98.2 months) from ABMR (3-year overall survival [OS] rate of 43% +/- 13% and event-free survival [EFS] rate of 47% +/- 14%]. Seven of these 10 patients also received irradiation post-ABMR. CONCLUSION: Myeloablative chemotherapy with ABMR followed by additional external-beam irradiation appears to be an effective retrieval therapy for some young children with recurrent malignant brain tumors.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1998

Antithrombotic therapy in patients with saphenous vein and internal mammary artery bypass grafts.

Aspirin (325 and 900 mg/d) is effective for a period of 1 year in reducing the frequency of saphenous vein bypass graft occlusion when begun 1 day before operation or on the day of operation. Aspirin in combination with dipyridamole is not more effective than aspirin alone in the prevention of saphenous vein graft occlusion. Bleeding is higher among patients treated with aspirin (325 mg/d) than among controls if aspirin is started 1 day before operation. Bleeding in one trial was greater than controls if aspirin (300 mg/d) was started the day of operation, and in one trial there was no difference when aspirin (325 mg/d) was started the day of operation. Ticlopidine (500 mg/d), started 2 days after operation, was effective in maintaining graft patency. Oral anticoagulants were inconsistent in the maintenance of saphenous vein graft patency. The continued use of aspirin for 2 additional years after an initial year of aspirin therapy for the prevention of saphenous vein bypass graft occlusion showed no additional long-term benefit on graft patency at the end of the third year. Antithrombotic agents given to patients with internal mammary artery bypass grafts showed no benefit in comparison to placebo because patency on placebo was high.

Anticoagulants↗
PubMed1998

Rationale and potential use of cytokines in the prevention and treatment of neonatal sepsis.

Despite advances in the use of newer antimicrobials and aggressive supportive care, sepsis and its sequalae remain a major source of morbidity and mortality in the neonate. The VLBW neonate is especially at high risk. We and others have demonstrated that neonatal MNC are deficient in their production of G-CSF and GM-CSF, which, in part, may explain the neonates propensity to develop neutropenia during times of sepsis. G-CSF and GM-CSF have been shown to both enhance neonatal neutrophil superoxide production in vitro and to increase circulating neutrophil numbers through expansion of the NSP in the BM in neonatal rats and humans. G-CSF is protective (if given with or before antibiotics) during experimental GBS in the neonatal rat and appears to be well tolerated (both short term and 2 years after its use) in the human neonate. In a phase II randomized pilot multicenter study, GM-CSF prophylaxis in the VLBW neonate was well tolerated during 4 weeks of administration and was noted to have significantly reduced the incidence of nosocomial infections. Future efficacy and safety studies in more neonates need to be completed and assessed before the routine pharmacologic use of G-CSF or GM-CSF is recommended to prevent and treat neonatal sepsis.

Animals↗
PubMed1998

Radiation induced renal cell cancer: a report of 4 cases and review of the literature.

PURPOSE: During clinical care in the University of Chicago renal cell carcinoma program there was 1 case of prior radiation therapy for a neuroblastoma (patient age 16 months). After this index case was found our investigation was conducted to identify other cases with apparent radiation therapy induced renal cell carcinoma and review the literature on the subject. MATERIALS AND METHODS: The clinical summaries of 573 cases from the University of Chicago renal cell carcinoma program from 1992 through 1998 were reviewed. RESULTS: Four cases (3 men and 1 woman) of renal cell carcinoma, including the index case, were identified with prior therapeutic radiation therapy. Of the patients 3, 32, 35 and 36 years old, had been radiated for neuroblastoma 31, 32 and 35 years, respectively, before diagnosis of renal cell carcinoma and 1 (age 64 years) had been radiated for testicular seminoma 25 years earlier. The 32-year-old patient had 2 primary renal cell carcinomas in the remaining kidney and an associated leiomyosarcoma. He was alive and disease-free on dialysis 8 years after diagnosis. The 35-year-old patient had localized well differentiated renal cell carcinoma and was disease-free for 24 months. The 36-year-old patient had relapse 7 years after nephrectomy and had progressive refractory disease 12 years after diagnosis. The 64-year-old patient had relapse in 2.5 years but was alive with metastatic disease 4 years later. A literature review documented 4 other patients with renal cell carcinoma of those with neuroblastoma treated with radiation therapy. CONCLUSIONS: Radiation therapy induced renal cell carcinoma is rare (less than 1% of renal cell carcinoma cases), and in our 4 cases it occurred 25 to 35 years after radiation. The risk of renal cell carcinoma should be considered during long-term followup of patients exposed to radiation therapy.

Adult↗
PubMed1997

Sexually transmitted infection as a cause of anal cancer.

BACKGROUND: The incidence of anal cancer has increased in recent decades, particularly among women. To identify underlying risk factors, we conducted a population-based case-control study in Denmark and Sweden. METHODS: We conducted telephone interviews with 324 women and 93 men in whom invasive or in situ anal cancer was diagnosed between 1991 and 1994, 534 controls with adenocarcinoma of the rectum, and 554 population controls. The interviews covered a wide spectrum of possible risk factors for anal cancer. Odds ratios were calculated by logistic regression. Specimens of anal-cancer tissue and samples of rectal adenocarcinomas were tested for human papillomavirus (HPV) DNA with the polymerase chain reaction. RESULTS: Multivariate analysis revealed consistent and statistically significant associations between measures of sexual promiscuity and the risk of anal cancer in both men and women. There was a significant trend toward an association between higher numbers of partners of the opposite sex in women (P<0.001) and men (P<0.05) and strong associations with a variety of venereal diseases. In women, receptive anal intercourse, particularly before the age of 30 years, and venereal infections in the partner were also associated with an increased risk (odds ratios, 3.4 and 2.4, respectively). Fifteen percent of the men with anal cancer reported having had homosexual contact, as compared with none of the controls (P<0.001). High-risk types of HPV, notably HPV-16, were detected in 84 percent of the anal-cancer specimens examined, whereas all rectal-adenocarcinoma specimens tested were negative for HPV. CONCLUSIONS: Our study provides strong evidence that a sexually transmitted infection causes anal cancer. The presence of high-risk types of HPV, notably HPV-16 (which is known to cause cancer of the cervix), in the majority of anal-cancer tissue specimens suggests that most anal cancers are potentially preventable.

Adult↗
PubMed1997

Rapamycin and p53 act on different pathways to induce G1 arrest in mammalian cells.

Certain growth regulatory kinases contain a common domain related to the phospho-inositol 3 (PI-3) kinase catalytic site. These include the ATM gene product, DNA-PKcs, and the target of rapamycin (TOR in yeast; and FRAP in mammalian cells). Rapamycin inhibits growth factor signalling and induces G1 arrest in many cell types. Some growth regulatory PI-3 kinases appear functionally linked to p53 and we have explored potential links between cellular effects induced by rapamycin and p53. In p53 null cells rapamycin inhibited cell cycling but did not induce G1 arrest. In cells which showed selective G1 arrest in response to rapamycin, rapamycin had no effect on basal levels of p53 protein. Similarly p21(WAF1) protein was not induced by rapamycin. The kinetics of the cellular p53/p21(WAF1) response to ionising radiation was unaffected by rapamycin; and the ability of growth factor to protect against p53-mediated apoptosis in response to DNA damage was also unaffected by rapamycin. The ATM gene is mutated in the cancer susceptibility syndrome ataxia telangiectasia (AT) but such mutant cells showed a similar sensitivity to rapamycin compared to their normal counterparts. RKO cell lines of common genetic background, but with different levels of functional p53 protein, also responded similarly to rapamycin. Thus, although rapamycin and p53 are each able to induce G1 arrest, they appear to act through independent growth regulatory pathways.

Animals↗
PubMed1997

Brain glucose metabolism in anorexia nervosa and affective disorders: influence of weight loss or depressive symptomatology.

Relationships between eating and affective disorders remain complex and unclear. Brain glucose metabolism of anorectic patients has been demonstrated to be reduced both globally and regionally, with a particular relative hypometabolism in the parietal cortex. To explore the possible influence of weight loss or depressive symptomatology on brain metabolism, we studied age- and sex-matched low-weight anorectic and depressed patients, normal-weight depressed patients, and healthy volunteers. Absolute global and regional glucose activity levels were reduced in low-weight patients, with the lowest values being found for anorectic patients. In relative values, anorectic patients showed a significant parietal hypometabolism in comparison to control subjects while they had higher metabolism in the caudate nuclei when compared with the other groups. Absolute hypometabolism of glucose seems to be a consequence of low weight as it was found in both low-weight anorectic and low-weight depressive patients. In addition, absolute glucose values were significantly correlated with body mass index in all subjects. Future positron emission tomographic studies in psychiatric patients should control for alimentary parameters.

Adolescent↗
PubMed1997

Cerebellar spongiform degeneration induced by acute lithium intoxication in the rat.

Cerebellar syndrome has been described after acute lithium intoxication in human. Neuropathological studies have demonstrated neuronal loss and spongiosis in the cerebellum. We describe an animal model of acute lithium-induced cerebellar degeneration. Five hours following administration of lithium chloride (250 mg/kg, i.p.), the cerebellar white matter of seven rats out 14 exhibited extensive spongiform changes. Microdialysis study in the rat cerebellar cortex demonstrated basal concentrations of dopamine (DA), hydroxy-3-methoxyphenylacetic acid (HVA) and 5-hydroxy-3-indolacetic acid (5-HIAA). These metabolites were unaffected by acute lithium intoxication suggesting that the cerebellar toxicity is not due to a modification of dopaminergic or serotoninergic neurotransmission.

Acute Disease↗
PubMed1997

Waddell's nonorganic signs and Minnesota Multiphasic Personality Inventory profiles in patients with chronic low back pain.

STUDY DESIGN: An analysis of clinical data gathered at an orthopedic outpatient clinic is presented. OBJECTIVE: To examine the relationship between Waddell scores and the Minnesota Multiphasic Personality Inventory response patterns. SUMMARY OF BACKGROUND DATA: Waddell's study of nonorganic signs of low back pain showed consistent correlations with Minnesota Multiphasic Personality Inventory scales 1 to 3. METHODS: A Waddell score was obtained from 507 consecutive patients with chronic low back pain to whom an Minnesota Multiphasic Personality Inventory also was administered. The sample was divided into those patients with a high Waddell score (high waddell score = 3 to 5) and those with a low Waddell score (low waddell score = 0 to 2); men and women were scored separately. RESULTS: Among male patients, statistically significant differences were found between the high Waddell score and low Waddell score groups on Minnesota Multiphasic Personality Inventory scales, 1, 3, and 8, but among females, differences were statistically significant only on scale 8. CONCLUSIONS: Correlations between the Waddell score and the first three scales of the Minnesota Multiphasic Personality Inventory were not fully replicated. The difference between the high Waddell and low Waddell groups on scale 8, however, was significant for men and women.

Adult↗
PubMed1997

Magnetic resonance imaging of the pediatric airway.

OBJECTIVE: To determine the role of magnetic resonance imaging (MRI) and how it relates to endoscopy as well as to other imaging modalities in the evaluation of pediatric airway disorders. DESIGN: A review study of children with various distal airway disorders over a 3-year period. Surgical procedures as well as all diagnostic imaging modalities were reviewed and analyzed with respect to clinical outcome. SETTING: Academic tertiary care children's hospitals. PATIENTS: Forty-nine children between the ages of 1 week and 14 years with the signs and symptoms of distal airway disorders. INTERVENTIONS: Forty-five of 49 children underwent airway endoscopy. Fourteen children also underwent fluoroscopy and 4 underwent echocardiography. When indicated, open surgical repair was performed and used to verify findings in 32 cases. RESULTS: Magnetic resonance imaging was the most accurate modality in defining extrinsic airway abnormalities. The findings of echocardiography were incorrect in 2 of 4 cases, and fluoroscopy, although accurate for tracheal narrowing and tracheomalacia, often could not elucidate that exact cause or missed left mainstem bronchial compression. Furthermore, tracheal narrowing to 50% or greater on MRI correlated 100% with the need for surgical intervention. CONCLUSIONS: Magnetic resonance imaging is a useful modality that has allowed us to accurately diagnose extrinsic pediatric tracheal abnormalities. In certain cases, MRI scans can be obtained prior to endoscopy. In those cases, definitive endoscopy and open repair are performed at the same procedure instead of at 2 separate procedures (ie, one for diagnostic endoscopy and the other for definitive repair).

Adolescent↗
PubMed1997

Brain hypometabolism of glucose in bulimia nervosa.

OBJECTIVE: A cerebral function lateralization has been described in bulimic patients in positron emission tomography (PET) studies realized during a specific cognitive task. The purpose of this study was to evaluate, at rest, brain glucose metabolism in patients with bulimia nervosa. METHOD: PET with (18-F)-fluorodeoxyglucose was used to evaluate cerebral glucose metabolism in 11 normal-weight bulimic girls compared to 11 age- and sex-matched healthy volunteers. Patients were diagnosed following DSM-IV and were off psychoactive medication. RESULTS: In comparison with control subjects, bulimic patients showed global and regional absolute hypometabolism of glucose. In relative values, only parietal cortex metabolism was significantly lower in bulimic patients. No correlation was found within groups for absolute or relative cerebral glucose metabolic rates (rCMRglu) and body mass index (BMI), anxiety scores, or Hamilton scores of depression. DISCUSSION: Since previous studies have demonstrated similar disturbances in anorectic patients, we hypothesized that these observations could be a consequence of neurobiological perturbations following nutritional deficiencies or a particular cerebral dysfunction in eating disorders.

Adolescent↗
PubMed1997

Stereotactic brain biopsy guided by positron emission tomography (PET) with [F-18]fluorodeoxyglucose and [C-11]methionine.

The aim of the present study was to compare the contribution of the labelled tracers [C-11]methionine (Met) and [F-18]-fluorodeoxyglucose (FDG) in positron emission tomography (PET)-guided stereotactic biopsy of non resectable brain lesions. Twenty-five patients underwent combined Met-PET-, FDG-PET- and computerized tomography (CT)- or magnetic resonance (MR)-guided stereotactic biopsy according to a previously described technique for stereotactic FDG-PET. Met-PET and FDG-PET images were analyzed to determine which tracer offers the best information to guide at least one stereotactic biopsy trajectory. Histological diagnosis was obtained in all patients (23 tumours and 2 non-tumorous lesions). All tumours had an area of abnormal Met uptake and were biopsied under PET-guidance. FDG uptake in the tumour was higher than in the grey matter and was used for target selection in 12 of 23 tumours. Eleven of them were located in the basal ganglia or the brainstem. Met was used for target selection in 11 of 23 tumours where there was no FDG uptake or where FDG uptake was equivalent to that of the grey matter. Ten of them were located in the cortex. Two nontumoral lesions had no Met uptake and were biopsied under CT- or MR-guidance only. Forty-three out of 53 stereotactic trajectories obtained in these 25 patients were based on PET-defined targets and had an area of abnormal Met uptake. These trajectories always yielded a diagnosis of tumour. Moreover, all tumorous trajectories had an area of abnormal Met uptake. Finally, all non-diagnostic trajectories (n = 4) were CT/MR-defined because there was no area of abnormal Met uptake. These results suggest that patients who can benefit the most from Met-PET guidance could be selected pre-operatively. In conclusion, this work shows that Met is a good alternative to FDG for target selection in PET-guided stereotactic brain biopsy.

Adolescent↗
PubMed1997

A simplified coculture system with luteinized granulosa cells improves embryo quality and implantation rates: a controlled study.

OBJECTIVE: To investigate the use of a simplified short-term coculture system with luteinized granulosa cells (GCs) in patients with failed IVF-ET. DESIGN: Controlled clinical study. SETTING: IVF unit, Department of Obstetrics and Gynecology, Carmel Medical Center. PATIENT(S): Patients with poor embryo quality in their previous IVF-ET cycles. INTERVENTION(S): Embryos from 40 patients, in which > 50% of the embryos were classified as poor quality in their previous IVF attempts, were grown on autologue GC culture system for a short period (24-48 hours) before being replaced in the uterine cavity. MAIN OUTCOME MEASURE(S): Embryo quality. RESULT(S): Significant decrease in poor quality embryos and increase in the proportion of good quality embryos were observed using a coculture system with autologue human GCs. Pregnancy rates in this groups of patients reached our standard IVF results during the same period. CONCLUSION(S): This study describes a simplified short-term coculture system with human autologue GCs. Poor quality embryos may be rescued to cleave regularly.

Cells, Cultured↗
PubMed1997

Attitudes and educational practices of obstetric providers regarding infant hepatitis B vaccination.

OBJECTIVE: To survey the current knowledge, attitudes, and practices of obstetric providers regarding the education of pregnant women about infant hepatitis B vaccination. METHODS: A questionnaire was mailed to 264 physicians providing obstetric services in San Francisco. Of these, 113 were confirmed to be providing prenatal care. RESULTS: Seventy-six obstetric providers returned completed questionnaires. Among eligible respondents, 79% believed that hepatitis B vaccine should be administered to all infants at birth, and 92% believed that it is feasible to educate all expectant mothers about infant hepatitis B vaccination. However, only 53% of respondents provided such education to all their pregnant patients. Only 23% provided education about other routine childhood immunizations. CONCLUSIONS: Obstetric providers in San Francisco are willing to educate pregnant patients about hepatitis B vaccination but are not always doing so. Providing education in a consistent manner may improve infant hepatitis B vaccination rates and may increase coverage with other childhood vaccines.

Female↗
PubMed1997

Bone marrow transplantation in children. Imaging assessment of complications.

As the use of BMT increases for the treatment of a variety of malignant and nonmalignant diseases in children, awareness of the complications that can occur in these children is important. The imaging appearance of the complications that may occur in the central nervous system, paranasal sinus, lungs, abdomen, and pelvis in children following BMT have been reviewed. CT and MR imaging examination with the use of contrast material as indicated is important for defining pathology in the brain. Plain films should be supplemented with CT examination as needed to identify and characterize disease in the paranasal sinuses and lungs. Finally, the use of ultrasound and CT is crucial for defining complications that may occur in the abdomen and pelvis.

Arterial Occlusive Diseases↗
PubMed1997

Brain hypometabolism of glucose in low-weight depressed patients and in anorectic patients: a consequence of starvation?

As low-weight anorectic patients presented a global as well as a regional absolute hypometabolism of glucose, we investigated a population of ten age- and sex-matched low-weight depressed patients without anorexia nervosa to evaluate the impact of weight loss on cerebral glucose metabolism evaluated by positron emission tomography and [18F]-fluorodeoxyglucose. Ten age- and sex-matched healthy volunteers were used as controls. Absolute global and regional glucose activity was significantly lower in anorectic and low weight depressed patients than in control subjects. Anorectic patients compared with normal control subjects also showed lower relative metabolism of glucose in the parietal cortex. Within patients, absolute hypometabolism of glucose seems to be a consequence of low-weight while there is a positive correlation between absolute metabolism of glucose and body mass index.

Adult↗
PubMed1997

Predictors of graft patency 3 years after coronary artery bypass graft surgery. Department of Veterans Affairs Cooperative Study Group No. 297.

OBJECTIVES: The purpose of this analysis was to define the factors that predict 3-year graft patency. BACKGROUND: The success of coronary artery bypass graft surgery (CABG) is dependent on vein graft patency after the operation. It has been well established by a series of Department of Veterans Affairs Cooperative Trials that aspirin (325 mg daily) improves saphenous vein graft patency early (7 to 10 days) and at 1 year, but not at 3 years after CABG. This analysis, based on one of these trials, defined factors that predict 3-year graft patency. METHODS: This analysis consisted of 266 patients, with 656 grafts that were patent 7 to 10 days after the operation, who underwent 3-year catheterization. To determine which patient-specific and/or graft-specific factors, or both, predict graft occlusion, a multivariate logistic regression analysis in terms of latent variables was used. It yielded a model that also took into account possible intraclass correlations. RESULTS: For a vein graft that was patent at 7 to 10 days after the operation, the positive predictors, according to univariate analysis, for that graft being patent at 3 years were cross-clamp time < or = 80 min (p < 0.001), vein preservation solution temperature < or = 5 degrees C (p = 0.009), bypass time < or = 2 h (p = 0.042), number of proximal anastomoses < or = 2 (p = 0.018), operation time < or = 5 h (p = 0.044) and continuous versus intermittent cross-clamp technique (p = 0.024). There was also a trend with regard to recipient artery diameter > 1.5 mm (p = 0.063), serum cholesterol < or = 225 mg/dl (p = 0.084) and single versus sequential or Y vein graft (p = 0.060). Factors not predictive of 3-year patency were age, race, smoking history, high density lipoprotein cholesterol, vein source (thigh vs. calf), coronary artery grafted and aspirin treatment. Of all the predictors obtained in the univariate analysis, the only variables that were sufficient to yield a good model within the multivariate analysis were solution temperature (p = 0.004), serum cholesterol (p = 0.024), number of proximal anastomoses (p = 0.032) and recipient artery diameter (p = 0.034). CONCLUSIONS: For a patient with patent vein grafts 7 to 10 days after the operation, predictors of 3-year graft patency are more closely related to operative techniques and underlying disease and not to aspirin treatment.

Coronary Artery Bypass↗