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Biomedical subjects

A Goodman

Publications and source records attributed to A Goodman.

At least 55 records · Page 3Linked to original sources
PubMed1998

Clinical evaluation of atypical glandular cells of undetermined significance on cervical cytology.

OBJECTIVE: To determine the incidence of and identify risk factors for clinically significant diagnoses associated with the diagnosis on Papanicolaou test of atypical glandular cells of undetermined significance. METHODS: A computer search was initiated of diagnoses of atypical glandular cells of undetermined significance at the Massachusetts General Hospital from January 1993 through December 1996. Seventy-three patients with 81 smears were identified that were seen in the Colposcopy Clinic. All cytology was reviewed. A clinically significant lesion was defined as high-grade squamous intraepithelial lesion (SIL) or worse, endocervical glandular atypia or worse, or carcinoma. RESULTS: The rate of diagnoses of atypical glandular cells of undetermined significance was 0.167%. All patients underwent colposcopy, and 88% underwent endocervical curettage. A clinically significant diagnosis was made in 34.2% of patients, including cancer in 8.2%. A concurrent squamous diagnosis carried a risk of clinically significant lesion of 50%, compared with a risk of 25.5% for atypical glandular cells of undetermined significance alone (P = .043). Premenopausal and postmenopausal patients were both at risk for clinically important lesions, but premenopausal patients were more likely to have a high-grade SIL (30.4% versus 7.4%, P = .04). The subtype "suggestive of reactive" was a significant negative predictor of significant lesion (odds ratio = 0.09, 95% confidence interval 0.018, 0.482) in a logistic regression model controlling for age, menopausal status, and concurrent squamous diagnosis. CONCLUSION: Atypical glandular cells of undetermined significance is an important Papanicolaou test diagnosis that needs appropriate and careful evaluation. Further studies are required to clarify areas of risk and to make triage algorithms.

Adult↗
PubMed1998

Fertility options for patients with stages IA2 and IB cervical cancer: presentation of two cases and discussion of technical and ethical issues.

BACKGROUND: Ten percent to 15% of women diagnosed with cervical cancer are in their childbearing years. Traditional therapy for stage IA2 and IB lesions, radical hysterectomy, negates future fertility potential. Assisted reproductive technology might offer these women fertility options. CASES: Two cases of young nulliparous women with stage IA2 cervical cancer, who underwent ovarian stimulation and oocyte retrieval followed by radical hysterectomy, were presented to illustrate the technical difficulties of oocyte stimulation and retrieval in the setting of cervical carcinoma. CONCLUSION: Many issues should be considered when counseling a woman with early-stage cervical cancer about future fertility. These include ethical issues of embryo freezing and gestational surrogacy and practical issues of ovarian preservation and transposition. No current guidelines exist to identify appropriate candidates for assisted reproductive technology in this setting.

Adult↗
PubMed1998

A microsatellite genetic linkage map for zebrafish (Danio rerio).

We have constructed a zebrafish genetic linkage map consisting of 705 simple sequence-length polymorphism markers (SSLPs). The map covers 2350 centimorgans (cM) of the zebrafish genome with an average resolution of 3.3 cM. It is a complete map in genetic mapping terms (there is one linkage group for each of the 25 chromosomes), and it has been confirmed by somatic-cell hybrids and centromere-mapping using half-tetrad analysis. The markers are highly polymorphic in the zebrafish strains used for genetic crosses and provide a means to compare genetic segregation of developmental mutations between laboratories. These markers will provide an initial infrastructure for the positional cloning of the nearly 600 zebrafish genes identified as crucial to vertebrate development,and will become the anchor for the physical map of the zebrafish genome.

Animals↗
PubMed1998

Recovery of spermatogenesis following bone marrow transplantation.

Preparative regimens used in bone marrow transplantation usually result in impairment of male fertility. Although recovery of fertility is more likely after chemotherapy-based regimens, this is a rare occurrence after TBI containing regimens. We undertook a cross-sectional study of recovery of spermatogenesis in men who had undergone allogeneic and autologous marrow or peripheral stem cell transplant between 1984 and 1995. We identified six out of 42 patients eligible for analysis to have either recovered fertility or spermatogenesis. Seminal fluid analysis showed that four out of 25 patients recovered sperm counts. This has important implications for patient counselling, post-transplant follow-up and contraceptive advice.

Adult↗
PubMed1998

Interagency collaboration in services for people with co-occurring mental illness and substance use disorder.

Historically the divisions between the mental health and substance abuse fields have been so deep that attempts to provide coordinated treatment across service sectors for people with dual diagnoses of psychiatric disorder and substance use disorder have failed. The authors describe a program in Maine designed to develop collaboratives, or communities of providers, who work together to offer coordinated mental health and substance abuse treatment and support. Surveys of provider agencies in one collaborative conducted one year and two years after the collaborative was established showed an increase in interagency referrals, joint assessments of clients, and jointly sponsored training and client services.

Alcoholics Anonymous↗
PubMed1998

Primary vaginal cancer.

Vaginal cancer, 2% of all female genital malignancies, has a worse prognosis than cervical cancer. Squamos cell carcinoma, the most common histologic subtype, may be associated partly with human papillomavirus. Most patients present with vaginal bleeding and discharge. Radiation or surgery are the main treatment modalities, but the physical and psychosexual morbidity can be significant.

Carcinoma, Squamous Cell↗
PubMed1998

Character healing: a fresh look at psychodynamic psychotherapy.

Caught between the successes of modern psychopharmacology, the requests of suffering patients for quick relief, and the shortsightedness of many third-party payers, psychodynamic psychotherapy might seem to be on the ropes. It is, however, thriving and providing crucial help to many individuals for whom medication and brief counseling are insufficient. Meanwhile, many more who could benefit from psychotherapy do not have an opportunity to do so. Although psychodynamic psychotherapy originated and developed within a medical framework, it has minimal visibility on the current medical scene, and many physicians have been provided with little meaningful information about it. This article is intended to give physicians a general idea of what psychodynamic psychotherapy is and how it works.

Character↗
PubMed1998

Masculinizing sclerosing stromal cell tumor in pregnancy: report of a case and review of the literature.

PURPOSE: To report a case of sclerosing stromal cell tumor of the ovary in pregnancy and to review the literature of this rare ovarian tumor. METHODS: The patient's office record and hospital record were reviewed. Gross and microscopic pathology were reviewed by one gynecologic pathologist. A Medline literature search and literature review were performed. RESULTS: Over eighty cases of sclerosing stromal cell tumor of the ovary have been reported in the literature since the definition of this pathologic condition in 1973. Only five cases have been reported during pregnancy and only two of these resulted in maternal virilization. This report describes severe maternal virilization with birth of a non-virilized female infant. CONCLUSION: Sclerosing stromal cell tumor of the ovary can result in severe virilization via androgen production. Surgery with removal of the involved ovary is required for diagnosis and cure. Prognosis is excellent.

Adult↗
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

The uptake of particulates by an urban woodland: site description and particulate composition.

Woodlands may improve local air quality by increasing the uptake rates of gaseous, particulate and aerosol pollutants from the atmosphere and can also act as relatively permanent sinks for some pollutants. Rough Wood, Walsall was selected for a study of the material which accumulates on tree foliage because of its location in a densely populated urban area, and its proximity to a motorway with high traffic flow (the M6) and to other pollutant sources. Methods were developed for leaf washing to allow determination of the quantity of dust and the identification of the dust particles present on oak leaves. Elemental analysis of particles was also undertaken using scanning electron microscopy coupled with electron probe microanalysis. A large proportion of particles were organic in origin. Of the inorganic particles, the majority contained silicon and aluminium in varying proportions suggesting that they were soil derived. Some particles were clearly identified as the products of combustion, and sea or road salt was present on leaf surfaces. Some particles contained copper, tin and titanium which may reflect the proximity of Rough Wood to local metal workings. The number of particles counted on leaf surfaces decreased as distance from the motorway increased.

Journal Article↗
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

Developing injury prevention capacity in New York City: the role of a local health department in fostering collaborations.

Injuries have long been a leading cause of mortality in urban areas such as New York City. While efforts to address injuries were undertaken by the New York City Department of Health (NYCDOH) starting in the 1940s, it was not until the department received a Capacity Building Grant from the Centers for Disease Control and Prevention (CDC) in 1989 that a more comprehensive program could be developed. The NYCDOH launched several collaborative projects with a variety of organizations and institutions. These efforts indicate that through collaborations, local health departments can increase their effectiveness and better promote their approach to injury prevention.

Community Networks↗
PubMed1997

Fluoxetine in depressed patients on dialysis.

OBJECTIVE: To test the safety and efficacy of fluoxetine in patients with renal failure on dialysis. METHOD: Fourteen patients with major depression and end stage renal disease on hemodialysis were randomized into two groups for an eight-week study. Subjects as well as investigators were blinded as to which subject received fluoxetine and which placebo. Patients were carefully monitored concerning adverse events, serum fluoxetine and norfluoxetine levels, and psychological measurements of degree of depression. RESULTS: No patients discontinued treatment because of adverse events, all of which were minor. All psychological tests showed improvement in depression at the four-week and eight-weeks point, although statistical significance could only be demonstrated at the fourth week of this study. All patients in the active group had serum plasma concentrations of fluoxetine and norfluoxetine less than 250 ng/ml at eight weeks, similar to levels in patients with normal renal function in a previous open label study. CONCLUSIONS: This study confirms the relative safety of fluoxetine in depressed patients in renal failure on hemodialysis. It also suggests that fluoxetine may be efficacious in depressed patients on dialysis.

Adult↗
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↗