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Biomedical subjects

A Goodman

Publications and source records attributed to A Goodman.

At least 19 recordsLinked to original sources
PubMed1997

Stage IB and IIA cervical cancer with negative lymph nodes: the role of adjuvant radiotherapy after radical hysterectomy.

The records of 171 patients with lymph node-negative stage IB and IIA cervical cancer primarily treated with radical hysterectomy and pelvic lymphadenectomy from 1974 to 1992 were retrospectively reviewed to identify poor prognostic factors and evaluate the role of adjuvant pelvic radiotherapy. One hundred sixteen patients (68%) were treated with radical hysterectomy alone (RH) and 55 patients (32%) received adjuvant radiotherapy (RH + RT). Factors predictive of recurrence for the entire group of patients included lymph-vascular space invasion (LVSI) (P = 0.003) and grade 3 histology (P = 0.04). Patients receiving RH + RT were older and more likely to have outer third cervical wall invasion, LVSI, positive margins, > or =2 cm pathologic tumor size, and >4 cm clinical tumor size (all P < 0.05). Overall, 28 patients (16%) developed recurrent disease with no difference between RH and RH + RT groups. After controlling for confounding variables, patients with LVSI who received RH + RT were less likely to develop disease recurrence than patients receiving RH alone (P = 0.04). LVSI is an important prognostic variable in lymph node-negative stage IB and IIA cervical cancer. Although adjuvant pelvic radiotherapy may decrease the risk of recurrence in patients with LVSI, the majority of patients with negative lymph nodes may be treated with radical surgery alone.

Adult↗
PubMed1997

Organic unity theory: an integrative mind-body theory for psychiatry.

The potential of psychiatry as an integrative science has been impeded by an internal schism that derives from the duality of mental and physical. Organic unity theory is proposed as a conceptual framework that brings together the terms of the mind-body duality in one coherent perspective. Organic unity theory is braided of three strands: identity, which describes the relationship between mentally described events and corresponding physically described events; continuity, which describes the linguistic-conceptual system that contains both mental and physical terms; and dialectic, which describes the relationship between the empirical way of knowing that is associated with the physical domain of the linguistic-conceptual system and the hermeneutic way of knowing that is associated with the mental domain. Each strand represents an integrative formulation that resolves an aspect of mental-physical dualism into an underlying unity. After the theory is presented, its implications for psychiatry are briefly considered.

Concept Formation↗
PubMed1997

The epidemiology and causes of injuries resulting in hospitalization in New York City: 1990-1992.

The purpose of this study is to present data on the distribution and etiology of nonfatal injuries resulting in hospital discharges in New York City (NYC). Records of all NYC residents discharged for injuries from acute stay hospitals 1990-1992 were tabulated. Injuries from surgical and medical procedures, adverse effects of drugs in therapeutic use, and late effects of injury were excluded. The results indicate that there was a marked geographic variation in rates: higher rates of assaults, self-inflicted injuries, burns, unintentional injuries from firearms, and injuries to bicyclists in disadvantaged neighborhoods. The data show that injuries in NYC have distinctive features that should form the basis for targeted prevention activities.

Accidental Falls↗
PubMed1996

Squamous cell carcinoma of the endometrium: a report of eight cases and a review of the literature.

BACKGROUND: Endometrial squamous cell carcinoma is extremely rare, with only 56 cases reported in the literature. METHODS: Six cases of endometrial squamous cell carcinoma were found in a review of 1182 cases of uterine corpus cancer treated at the Massachusetts General Hospital from 1975 to 1993. Two additional cases were seen in pathological consultation. The clinicopathological features of these 8 cases and the 56 reported cases were analyzed. RESULTS: The average age of the patients was 67 years; almost all of them were postmenopausal. The most frequent presenting symptom was vaginal bleeding. Chronic pyometra and nulliparity were predisposing factors. The average duration of symptoms before diagnosis was 11.5 months. Total abdominal hysterectomy with bilateral salpingo-oophorectomy was the primary treatment in 58 patients. Eighty percent of the patients with Stage I tumors survived; the median follow-up time was 32 months. The survival rate for patients with Stage III tumors was only 20%, and all 6 patients with Stage IV disease died. CONCLUSIONS: The preoperative diagnosis of endometrial squamous cell carcinoma may be difficult, since curettage specimens may show only highly differentiated squamous epithelium. The strong relationship between tumor stage and survival suggests that early diagnosis and treatment are imperative.

Aged↗
PubMed1996

The effect of postsurgical therapy on stage III endometrial carcinoma.

The records of 86 pathologic stage III endometrial carcinoma patients treated at Massachusetts General Hospital between 1974 and 1992 were retrospectively reviewed to identify predictors of poor outcome and to determine the effect of postsurgical therapy on recurrence and survival. Patients underwent TAH/BSO with selective lymphadenectomy and peritoneal washings. Cases prior to 1988 were retrospectively restaged using the FIGO surgical staging criteria. Postoperatively, patients received individualized regimens of EBRT (external beam radiotherapy), brachytherapy, and cytotoxic or hormonal chemotherapy. The 5-year survival and 5-year disease-free survival (DFS) for all patients were 54 and 44%, respectively. Forty-two percent of stage IIIA/B patients recurred in a median time of 14 months. Fifty-four percent of stage IIIC patients recurred in a median time of 16 months. Of patients who recurred, 90% stage IIIA/B and 71% stage IIIC patients recurred at extrapelvic sites. Age greater than 70, high-grade lesions, and fallopian tube metastases were predictive of poor outcome in stage IIIA/B by multivariate analysis. Vascular invasion was the only poor prognostic factor identified by multivariate analysis in stage IIIC disease. No benefit from pelvic EBRT in stage IIIA/B could be identified. Stage IIIC patients had increased DFS and a trend for increased survival with pelvic EBRT. Chemotherapy did not improve survival in either group.

Adult↗
PubMed1996

Fluoxetine in depressed patients with renal failure and in depressed patients with normal kidney function.

Nine depressed patients with normal kidney function and seven depressed patients with renal failure undergoing hemodialysis were treated with open-label fluoxetine 20 mg/day in an 8-week study. The study was designed to evaluate the pharmacokinetics of fluoxetine during repeated administration and to acquire preliminary data regarding the effectiveness of this antidepressant in a population undergoing hemodialysis. Six patients in each group completed the study. Of these, five patients undergoing hemodialysis and five patients with normal renal function experienced moderate to marked improvement in their depression. Side effects were equal and minor in both groups, indicating that fluoxetine is safe in patients with renal impairment. The mean +/- standard deviation steady-state plasma concentrations of the sum of fluoxetine plus its metabolite norfluoxetine for patients completing 8 weeks (N = 6, both groups) were comparable for the patients undergoing hemodialysis (253 +/- 61 ng/ml) and those with normal kidney function (218 +/- 122 ng/ml; t = 1.5, df = 70, p > 0.13). These data suggest that the efficacy of fluoxetine in patients with renal failure undergoing hemodialysis is comparable to that in patients with normal kidney function. These data further suggest that renal failure and the process of hemodialysis do not materially alter the pharmacokinetics of fluoxetine or its major metabolite norfluoxetine.

Adult↗
PubMed1996

A reference cross DNA panel for zebrafish (Danio rerio) anchored with simple sequence length polymorphisms.

The ultimate informativeness of the zebrafish mutations described in this issue will rest in part on the ability to clone these genes. However, the genetic infrastructure required for the positional cloning in zebrafish is still in its infancy. Here we report a reference cross panel of DNA, consisting of 520 F2 progeny (1040 meioses) that has been anchored to a zebrafish genetic linkage map by 102 simple sequence length polymorphisms. This reference cross DNA provides: (1) a panel of DNA from the cross that was used to construct the genetic linkage map, upon which polymorphic gene(s) and genetic markers can be mapped; (2) a fine order mapping tool, with a maximum resolution of 0.1 cM; and (3) a foundation for the development of a physical map (an ordered array of clones each containing a known portion of the genome). This reference cross DNA will serve as a resource enabling investigators to relate genes or genetic markers directly to a single genetic linkage map and avoid the problem of integrating different maps with different genetic markers, as must be currently done when using randomly amplified polymorphic DNA markers, or as has occurred with human genetic linkage maps.

Alleles↗
PubMed1996

Cell surplus on sampling devices after routine cervical cytologic smears. A study of residual cell populations.

OBJECTIVE: To demonstrate whether considerable valuable cellular material remains on the sampling device after a conventional cervical cytologic smear and to investigate whether evidence of cervical disease may be present on the sampling device but missed because it is not represented on the first slide. STUDY DESIGN: Routine cervical cytologic smear material was taken from 60 women who were attending the colposcopy or gynecologic oncology clinic at New England Medical Center. At the time of the colposcopic examination, a cervical scrape was made using a Cytobrush followed by a Cervex brush. After the smear was made from each device, the sampling devices were also used to make four additional slides. Both the Cytobrush and Cervex brush were applied to each slide. RESULTS: Cytologically, all five slides were satisfactory for screening in the 60 cases. In all diagnostic cases but one, disease was well represented across all five slides. CONCLUSION: Cellular material collected in a cervical scrape is sufficient to prepare at least five satisfactory smears. The one case where an abnormality was detected only on the third slide suggests the possibility of nonrandom subsampling and of discarding the majority of the cellular material from the patient.

Cervix Uteri↗
PubMed1995

Uterine papillary serous carcinoma (UPSC): a clinicopathologic study of 30 cases.

Between 1975 and 1989, 896 patients were treated for endometrial carcinoma at the Massachusetts General Hospital. Thirty patients were identified from the tumor registry as having uterine papillary serous carcinomas. The survival for all patients and for groups of patients stratified on clinical and pathological parameters was examined in the Kaplan-Meier survival curves. Curves for the different strata were compared using the logrank test. The 5-year survival for the 30 patients was 30% +/- 9%. Patients with surgical stage I and II tumors had a 5-year survival rate of 79% +/- 14% compared to 25% +/- 10% in patients with stage III and IV tumors (P = 0.02). Clinical stage, depth of myometrial invasion, lymph-vascular space invasion, tumor grade, and DNA aneuploidy were not found to significantly impact on survival. However, a survival advantage was seen in patients diagnosed with early surgical stage tumors, reinforcing the need for thorough staging at the time of laparotomy.

Aged↗
PubMed1995

A genetic linkage map of the laboratory rat, Rattus norvegicus.

We report the construction of the first complete genetic linkage map of the laboratory rat. By testing 1171 simple sequence length polymorphisms (SSLPs), we have identified 432 markers that show polymorphisms between the SHR and BN rat strains and mapped them in a single (SHR x BN) F2 intercross. The loci define 21 large linkage groups corresponding to the 21 rat chromosomes, together with a pair of nearby markers on chromosome 9 that are not linked to the rest of the map. Because 99.5% of the markers fall into one of the 21 large linkage groups, the maps appear to cover the vast majority of the rat genome. The availability of the map should facilitate whole genome scans for genes underlying qualitative and quantitative traits relevant to mammalian physiology and pathobiology.

Animals↗
PubMed1994

Localization of erythropoietin mRNA in the rat kidney by polymerase chain reaction.

Erythropoietin (Epo) is a glycoprotein secreted by kidney cells which plays an important role in the regulation of erythropoiesis. Localization of the Epo production by immunohistochemical studies and in situ hybridization has not been definitively established and is still a matter of controversy. Epo and glyceraldehyde 3-dehydrogenase (GAPDH) mRNA levels were determined in total RNA isolated from control and CoCl2-treated rats using a coupled reverse transcriptase/polymerase chain reaction method (RT/PCR). As indicated by the amount of amplification product, Epo mRNA levels were several-fold higher in CoCl2-treated rat kidney. In contrast, GAPDH mRNA levels were similar in control and CoCl2-treated rats. This RT/PCR method was also used to assess the level of Epo and GAPDH mRNA in microdissected nephron segments. All nephron segments tested lacked any detectable levels of Epo mRNA in either control or CoCl2-treated rats. On the other hand, peritubular cells (capillary fraction: afferent/efferent arteriole, vasa recta) were the only cells where the Epo mRNA was detected. Using a specific primer for GAPDH, the RT/PCR method could identify GAPDH mRNA in all microdissected nephron segments where the Epo mRNA was not expressed. Thus, a combination of microdissected nephron segments and RT/PCR enabled us to detect GAPDH mRNA populations in all nephron segments, whereas the failure to detect Epo mRNA in all segments but the capillary fraction, is due to the specific and localized expression of the Epo gene to this fraction.

Animals↗
PubMed1994

Surgical stage IV endometrial carcinoma: a study of 47 cases.

Between 1976 and 1991, 47 patients with surgical Stage IV endometrial carcinoma were treated. Patients were identified from the tumor registry and charts were retrospectively reviewed. Surgical curves using the Kaplan-Meier product-limit method and Cox regression analysis were used to identify independent prognostic factors. Overall, median survival was only 12 months. Using univariate analysis there was no statistically significant difference in survival between age (P = 0.41), histology (P = 0.54), grade (P = 0.91), disease site (P = 0.32), or clinical stage (P = 0.87). In patients whose disease was surgically cytoreduced, the median survival was 18 months compared to 8 months in those who did not undergo surgery (P = 0.0001). Evaluation of other treatment modalities by univariate analysis revealed improved survival in those patients who received cyclophosphamide, doxorubicin, and cisplatin (P = 0.0007), decreased survival in those who received radiation therapy compared to surgery (P = 0.023), and no statistically significant difference in survival with progestins. By multivariate analysis successful cytoreduction was the only statistically significant prognostic variable (P = 0.04). This 15-year retrospective review confirms that prognosis for women with Stage IV endometrial cancer is extremely poor. However, if hysterectomy with cytoreduction is feasible, surgery should be performed because survival may be improved.

Aged↗
PubMed1994

Molecular genetic changes associated with ovarian cancer.

Multiple specific chromosomal deletions can be found in human epithelial ovarian cancer by cytogenetic analysis or molecular techniques. Somatic allelic deletion or loss of heterozygosity (LOH) in a tumor is considered circumstantial evidence for the location of tumor suppressor genes. We have examined 27 primary epithelial ovarian tumors for the presence of LOH at 19 polymorphic markers on chromosomes 1, 5, 6, 9, 11, 13, and 17. Markers near the adenomatous polyposis coli (APC) gene at 5q21 showed LOH in 50% (10/20) of informative cases. LOH was seen in 53% (8/15) at the IFNA locus on 9p, another region implicated in other tumors, but not previously associated with ovarian cancer. We observed LOH for markers on 11p15 in 50% (12/24) of ovarian cancer DNAs from informative cases, while only 25% (4/16) at 11q13 and 29% (5/17) at 11q24 showed LOH. Only a portion of distal 11p was deleted in six cases. The incidence of LOH (50%) at HGH (17q22-q24) was greater than that at D17S579 (39%; 17q21), a locus tightly linked to BRCA1. Sixty-four percent (7/11) showed allelic loss at 17p11. LOH was infrequently observed at markers on chromosomes 1, 6, and 13q. Most cases showing LOH were stage III or IV, and most showed LOH at more than one locus. These studies support the concept that multiple genetic loci are involved in ovarian tumorigenesis. Two additional regions thought to harbor genes important in other cancers, 5q21 and 9p21, can now be added to the growing spectrum of molecular alterations seen in ovarian cancer.

Adult↗
PubMed1994

Homogeneous sampling accounts for the increased diagnostic accuracy using the ThinPrep Processor.

Recent clinical trials indicated that the ThinPrep method of sample preparation has greater diagnostic sensitivity than the conventional direct Papanicolaou smear. The authors hypothesized that nonhomogeneous cell sampling during transfer from the sampling device to the microscope slide was a contributing factor to the reduced accuracy of the conventional direct Pap smears in these trials. To test this hypothesis, four direct smear methods were compared with the newly developed, fluid-based, filter-transfer method. Counts of epithelial cells on conventional smears showed that only a fraction of the available epithelial cells on the sampling devices (medians, 6.5% to 62.5%) was actually deposited on the slides. In all 27 cases studied with the ThinPrep method, equivalent diagnostic material was obtained on each of the replicate slides prepared per specimen. This identifies a new source of error, preparation error, in conventional smears.

Cell Biology↗
PubMed1994

Chromic phosphate therapy in carcinoma of the ovary.

BACKGROUND: Adjuvant therapy with intraperitoneal (IP) chromic phosphate (P-32) instillation in both early and advanced carcinoma of the ovary requires adequate intra-abdominal distribution for maximum therapeutic benefit. Abdominal-pelvic computed tomographic (CT) scanning with water-soluble IP contrast to establish the absence of intra-abdominal adhesions prior to P-32 instillation has not been previously reported. STUDY DESIGN: Sixteen patients with carcinoma of the ovary who were offered IP P-32 therapy between January 1988 and December 1992 were retrospectively reviewed. Computed tomographic scans on 13 patients were reevaluated using a modification of Muggia and associates' distribution scoring system. RESULTS: Of the 16 patients, one had a negative second look operation for stage IIIc carcinoma of the ovary. The remaining 15 with stage I and II disease underwent at least a staging laparotomy, bilateral salpingo-oophorectomy, and omentectomy. The mean time from operation to IP P-32 attempt was 28 days with a range of 17 to 90 days. Adequate distribution was considered present in two of the three cases evaluated by technetium scanning and in four of the 13 cases studied by CT scanning. On review, 12 of 13 cases studied by CT scans revealed some areas of IP contrast exclusion and loculation. CONCLUSIONS: We suspect that uneven postoperative IP P-32 distribution is common and may be missed by two-dimensional imaging techniques such as technetium scanning or fluoroscopy.

Adult↗
PubMed1993

Lead exposure among automobile radiator repair workers and their children in New York City.

Despite a comprehensive Occupational Safety and Health Administration lead standard, exposure to lead continues in many industries. This paper describes a blood lead screening and education program for automobile radiator repair workers and their families in New York City. Results showed that 67% of automobile radiator repair workers (n = 62) in 89% of the shops tested (n = 24) had blood lead levels in excess of 25 micrograms/dl. The vast majority of workers had never been tested previously, and none had received health and safety training regarding occupational lead exposure. Although none of the workers' children's blood lead levels were in excess of then-current guidelines, several had levels which may be associated with subclinical toxicity and in excess of the revised Centers for Disease Control guidelines of 10 micrograms/dl. This project demonstrates that lead exposure in the automotive radiator repair industry continues to be widespread and that local health departments can assist in hazard identification and remediation.

Adult↗
PubMed1993

DNA ploidy status: its impact on early-stage endometrial adenocarcinoma.

DNA ploidy status, as determined by flow cytometry, has been useful in predicting survival in certain malignancies. Between January 1975 and January 1985, 85 cases that met the inclusion criteria-pathologic stage I endometrial adenocarcinomas, primary surgical therapy, endometrioid cell type, and adequate paraffin-block samples-were analyzed by DNA flow cytometry. Depth of myometrial invasion, tumor grade, and presence of lymphatic vascular space invasion were established in all cases. Ten of the 85 tumors (12%) were aneuploid. The median follow-up was 9 years with a range of 2 to 16 years. There were 9 recurrences with 5 deaths from cancer, and 8 patients died of intercurrent disease. The relative hazards for recurrence associated with aneuploidy, S-phase fraction, grade 3 histology, and any myometrial invasion were 3.1, 3.18, 3.2, and 4.9, respectively, but did not reach statistical significance. Because of the low recurrence and mortality rate in this homogeneous group, a larger sample will be necessary to fully establish a role for DNA ploidy status in identifying a poor prognostic subset.

Adenocarcinoma↗