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Biomedical subjects

C Goldberg

Publications and source records attributed to C Goldberg.

At least 19 recordsLinked to original sources
PubMed1998

Cognitive-behavioral therapy for panic: effectiveness and limitations.

The cognitive model of panic and cognitive-behavioral therapy were evaluated. It was argued that the cognitive model is not clear about the definition of threat, and that panic is evoked by the fear of the dissolution of the self. Furthermore, panic attacks will not lead to panic disorder unless the individual is experiencing general anxiety and is concerned with his/her physical or mental state. Controlled studies have demonstrated that cognitive-behavioral therapy is superior to other treatments for panic--85% of patients are panic-free at posttreatment and improvements are maintained at follow-up. However, 26% of waiting-list controls are also panic-free making the net percentage of panic-free treated patients 59%. There is room for improvement in at least 50% of patients, and a substantial number of patients continue to take medication and seek additional treatment. There is a need to determine the essential components of cognitive-behavioral therapy. It was predicted that exposure will prove to be the most crucial component. Exposure to phobic situations and interoceptive cues should be extended to the underlying causes of panic disorder, such as concerns with identity and dependency needs.

Cognitive Behavioral Therapy↗
PubMed1997

Patterns of mobilization of copper and iron following myocardial ischemia: possible predictive criteria for tissue injury.

Direct evidence for substantial iron and copper mobilization into the coronary flow immediately following prolonged, but not short, cardiac ischemia is presented. When small volumes of coronary flow fractions (CFFs) were serially collected upon reperfusion, after 25-60 min of ischemia, the copper and iron levels in the first CFF were 50-fold and 12- to 15-fold higher, respectively, than corresponding pre-ischemic values. The copper and iron levels after shorter periods (15-21 min) of ischemia were only about five-fold higher than the pre-ischemic values. This demonstrates that the resumption of coronary flow is accompanied by a burst of both metal ions. The levels of Cu/Fe in the CFFs correlated well with the loss of cardiac function following global ischemia of varying duration. After 18 min of ischemia, the residual cardiac function was less than 50%, and the damage was essentially reversible. After 25 min of ischemia, it exceeded 50% and was only partially reversible, while after 35 min, the damage exceeded 80%, and was mostly irreversible. The results are in accord with the hypothesis that copper and iron play causative roles in myocardial injury through mediation of hydroxyl radical production. Thus, the pattern of Cu/Fe mobilization from the tissue into the CFF can be used for the prediction of the severity of myocardial damage following ischemia, and could be developed into useful modalities for intervention in tissue injury.

Animals↗
PubMed1993

Contributing factors associated with agoraphobia.

24 agoraphobics, 6 panic subjects, and 27 normal controls were compared on several factors assumed to be associated with agoraphobia. As compared to controls, agoraphobics scored higher on these factors, but, in general, there were no differences between agoraphobics and panic subjects without agoraphobia.

Adaptation, Psychological↗
PubMed1990

A prospective randomised controlled trial of antimicrobial prophylaxis in hydrocephalus shunt surgery.

Despite attempts to reduce their incidence, shunt infections remain a major complication of the treatment of hydrocephalus. Various forms of antimicrobial prophylaxis are in use, but no controlled, statistically valid trial has been conducted to assess their efficacy. Such a trial was therefore carried out and its design is described here. After a 1-year retrospective and prospective study by members of the United Kingdom Hydrocephalus Group to establish feasibility and infection rates, a statistical study showed that at least 712 patients would be required. Six centres were enrolled to fulfil these requirements, and ethical committee approval was obtained at each. The chosen prophylactic regimen was 10 mg vancomycin administered into the ventricular system during surgery. Adults and children undergoing insertion or revision of ventriculoperitoneal shunts were included unless they were receiving therapeutic antimicrobials. Randomisation was by computer-generated numbers. Controls received the antimicrobial regimen, if any, currently used in that centre, the only difference between the two groups being intraventricular vancomycin in the test group. Diagnosis of shunt infection included accepted clinical and microbiological criteria reinforced by measurement of serum C-reactive protein levels. Follow-up was for at least six months. After 2.5 years only 158 patients had been enrolled in the trial, 80 controls and 78 tests. There were 5 preventable infections in the control group and 2 in the test group. In view of the small total the planned statistical analysis was not possible. Therefore, while no problems were encountered with toxicity, the trial failed to enroll enough patients to answer the question of efficacy of antimicrobial prophylaxis in shunt surgery and the reasons for this are discussed.

Cerebrospinal Fluid Shunts↗
PubMed1990

Handedness and scoliosis convexity: a reappraisal.

The handedness of 254 girls with idiopathic scoliosis, minimum age eight years at diagnosis, attending Our Lady's Hospital was related to their scoliosis convexity. Curve patterns were assigned to right or left on the basis of the convexity of the low thoracic component only, regardless of primary curve. The curve pattern matched handedness in 82%. Of 228 right-handed children, 197 had a right convex curve pattern; of 26 left-handed children, 12 had a left convex pattern. The correlation between scoliosis configuration and handedness was statistically significant. This is in contrast to the findings of previous studies, which have considered convexity only, without reference to the configuration of the whole spine. The implication of this finding is that scoliosis is associated with cortical functions.

Child↗
PubMed1989

Equilibrial dysfunction in scoliosis--cause or effect?

To determine whether equilibrial dysfunction is the cause or effect of idiopathic scoliosis, patients with idiopathic scoliosis, congenital scoliosis, and comparable controls were tested, using clinical postural tests and electronystagmographic recording of spontaneous and positional nystagmus, smooth visual pursuit, and rotation-induced nystagmus. The scoliosis patients were stratified as progressive or nonprogressive. Dysfunctional responses occurred in the idiopathic progressive and congenital progressive groups, and in two idiopathic non-progressive patients whose curves subsequently deteriorated. These results suggest that equilibrial dysfunction is characteristic of patients with progressive curves, regardless of etiology, implying that it is secondary to the curve rather than a primary event. Seven patients with progressive curves undergoing surgical correction and stabilization were tested preoperatively and 6 months postoperatively. No change in the responses occurred, suggesting the dysfunction persists at least 6 months following arrest of progression.

Adolescent↗
PubMed1988

Electro-spinal stimulation in children with adolescent and juvenile scoliosis.

A series of forty-one patients with adolescent or juvenile idiopathic scoliosis who were treated with electro-spinal stimulation is reported. Nineteen children were removed from the program because of curve progression or unacceptable deformity. Sixteen of these (39%) required surgery as a first alternative. Three were given a brace. Thirteen children have reached skeletal maturity without significant deterioration. Those who did well were in a lower risk category. The efficacy of this form of treatment has not been demonstrated in this series, and it is being discontinued.

Adolescent↗
PubMed1986

Status of a group of spina bifida children not managed by early surgery.

At Our Lady's Hospital for Sick Children, Crumlin, the policy towards neonates with Spina Bifida is one of individualised care. This means that those children who, experience has shown, will not be long term survivors are not subjected to procedures that are distressing and traumatic to the infant and parents. They are given full nursery care. A small number of children treated on this basis thrive. The question arises whether or not they have been further handicapped by this approach. Since this is a problem which causes concern to both parents and clinicians, this study reviews the present state of these survivors. In the five year period 1979-1983, there was a total of 192 infants admitted to Our Lady's Hospital with open myelomeningocoele. 66 were treated with early surgical intervention. 75 died without any surgical procedure at a mean of 46 days. 51 children underwent late intervention, despite which 29 died. A group of 22 are alive, aged 3-7 years. The mean first admission of these 22 patients was 77 days and was uneventful. However, all 22 are severely handicapped; all are paraplegic, doubly incontinent and have some degree of mental handicap. All have hydrocephalus graded moderate to gross and 17 have been shunted. Amongst these 22 surviving patients, we have been unable to identify, in the initial period, specific events or developments which have clearly caused additional damage to the infant's intellectual or physical well-being.

Cerebrospinal Fluid Shunts↗
PubMed1986

Should the tradition of right cerebral hemisphere shunting still prevail?

A review of the literature suggests that the right hemisphere compared with the left may be more sensitive to, and take longer to recover from, cerebral trauma. As there are also grounds for suggesting that shunting may be associated with limited cerebral insult, it is possible to conclude that, theoretically, left hemisphere shunting may be a preferable policy.

Cerebral Cortex↗
PubMed1984

A review of the management policy for new-born spina bifida children at Our Lady's Hospital for Sick Children, Crumlin, 1973-1983.

The management policy at Our Lady's Hospital for Sick Children, Crumlin, for newborn spina bifida infants consists of immediate operation for those considered likely to benefit and full nursery care for those who do not have early surgery. In the eleven years since this policy was first implemented, there have been 493 infants admitted with open myelomeningocele, of whom 260 (52.7%) were managed non-operatively. The mortality for all infants so managed was 78% at one year. 171 (66%) of this group died without further intervention. 89 (34%) survived long enough for some form of treatment to be instituted. 41 of these children are still alive and it is felt that their handicaps have not been increased by their early management. It is argued that an approach to management which considers the needs and interests of the individual infant is more acceptable than one that seeks to enforce total care, regardless of circumstances, or the impersonal assignment, by criteria, into "treatment" and "non-treatment" groups.

Cerebrospinal Fluid Shunts↗