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Biomedical subjects

H L Goldberg

Publications and source records attributed to H L Goldberg.

At least 19 recordsLinked to original sources
PubMed1997

Chest cancer refers pain to face and jaw: a case review.

The dentist's sphere of treatment is generally limited by state law to the teeth, alveolar process, gums, cheeks, jaws or oral cavity and associated structures. However today, an appreciation of the total person is necessary. Pain referred from the chest to the face and jaw is presented to the new student when first assuming responsibility for treatment of the clinic patient. With contemporary dental practice expanded to orofacial pain and the temporomandibular joint area, general medical knowledge is essential. Without hesitancy, when the situation is not distinct, referral for medical consultation may be the best part of patient care.

Carcinoma, Neuroendocrine↗
PubMed1994

Psychotropic drugs in pregnancy and lactation.

OBJECTIVE: This article reviews the literature on the use of psychotropic drugs in pregnancy and lactation. METHOD: Medline search yielded more than five hundred titles. Articles were reviewed and ninety-one were selected for reference. RESULTS: Fetal physiology and teratogenicity are discussed and the effects of specific drugs on the fetus and newborn are presented. When possible, recommendations for use or non-use are presented. CONCLUSIONS: Though no controlled studies have ever been done in pregnant women to truly prove their safety, it appears that most, but not all, current psychotropic drugs appear fairly safe for use in pregnancy.

Clozapine↗
PubMed1993

Value and limitations of heart rate-adjusted ST segment depression criteria for the identification of anatomically severe coronary obstruction: test performance in relation to method of rate correction, definition of extent of disease, and beta-blockade.

Performance of the linear regression-based ST/HR (heart rate) slope, the simple ST/HR index, and ST segment depression alone for the identification of anatomically severe coronary obstruction was examined in relation to the definition of the extent of disease and the presence or absence of beta-blockade during treadmill exercise using the Cornell protocol in 172 catheterized patients. Whether severe disease was defined by three-vessel obstruction, by Gensini scores partitioned at 35 or at 48, or by Duke jeopardy scores exceeding 6, the 83% to 100% sensitivities of an ST/HR slope criterion of 6.0 microV/beat/min were each significantly higher than the corresponding 65% to 80% sensitivities of 150 microV of ST segment depression closely matched specificities. The ST/HR slope was significantly more sensitive than a simple ST/HR index criterion of 3.4 microV/beat/min for detection of high Gensini scores, but despite consistently intermediate performance trends, in no case did sensitivity of the simple ST/HR index criterion significantly exceed that of ST depression alone. Each method performed better and with comparable sensitivity in patients not receiving beta-blockers. In contrast, the 82% to 100% sensitivities of the ST/HR slope for identification of severe disease were significantly higher than the 63% to 77% sensitivities of ST depression in patients taking beta-blocking drugs; however, simple heart rate adjustment using the ST/HR index had intermediate performance that in no case was significantly more sensitive than ST segment depression alone.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenergic beta-Antagonists↗
PubMed1991

Hemodynamic changes during retrograde left-heart catheterization in patients with aortic stenosis.

Pulmonary artery pressures in patients with aortic stenosis have been related to postoperative prognosis and surgical risk. However, while right- and left-heart pressures should be measured simultaneously, a catheter lying across the stenotic aortic valve might alter left- and right-heart pressures. To assess this phenomenon, right- and left-heart pressures were recorded before and after retrograde crossing of the aortic valve in 51 patients (30 patients with and 21 without aortic stenosis). In aortic stenosis, the mean pulmonary artery pressure increased (p less than 0.001) after transaortic valvular pressure catheter placement (average 4 mm Hg, peak 19 mm Hg); in the absence of aortic stenosis, the mean pulmonary artery pressure did not change (average 0 mm Hg; NS). A similar response was noted for the mean pulmonary capillary wedge pressure. Hemodynamic changes did not correlate with the severity of aortic stenosis or with left ventricular performance. Right-heart pressures should be determined without transaortic valvular catheter in place, if accurate interpretation of the hemodynamic effects of aortic stenosis is to be achieved.

Aortic Valve Stenosis↗
PubMed1990

Relative insensitivity of densitometric stenosis measurement to lumen edge determination.

Coronary artery stenosis measurement from coronary arteriograms is dependent on lumen edge determination. In theory, dependence may be minimized by densitometric integration of the entire lumen as compared with densitometric determination of edges alone coupled with calculation of lumen size by geometric formulas. To assess the impact of approximations of lumen border position when densitometric and geometric methods are employed, external, intermediate and internal borders were defined and used with each method to calculate lumen narrowing from images of contrast-filled, asymmetrically stenotic model vessels and from clinically generated coronary arteriograms. Actual cross-sectional area narrowing of models correlated almost perfectly with densitometric narrowing for each of the three border criteria (external: r = 0.99, n = 192; intermediate: r = 0.99, n = 192; internal: r = 0.99, n = 192). Lumen narrowing calculated by assuming a circular lumen geometry with a diameter equal to the distance between these identical borders correlated less well with true area narrowing (external: r = 0.79, n = 192; intermediate: r = 0.83, n = 192; internal: r = 0.78, n = 192); the residual variance of the densitometric regression was significantly less than that of the geometric regression for each of the three border criteria (external: 8.13 versus 372, p less than 0.001; intermediate: 7.39 versus 315, p less than 0.001; internal: 7.13 versus 531, p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Angiography↗
PubMed1990

Trauma and the improbable anterior displacement.

There is little doubt that an individual involved in a motor vehicle accident has received some shock, whether blunt trauma or a cervical spinal whiplash has occurred. However, the severity of the trauma and the individual response is unique. Anterior disk displacement is easy to explain to third parties, since the lay concept is a cap (disk) on the condyle that is waiting to be dislodged. It is, therefore, the most frequently diagnosed injury and generally accepted without question. The possibility that this is a pre-existing derangement is discussed, and the requirements for displacement are described.

Accidents, Traffic↗
PubMed1989

Modern treatment modalities in anxiety.

Developments in the medical management of anxiety tend, over the last two decades, to have clustered around modifications to the early benzodiazepines. These developments have given the psychiatrist a wide range of options in terms of intensity and duration of action but have carried with them the range of penalties associated with the benzodiazepines as a group. These include among others addiction potential and a sometimes inappropriate level of sedation. The need has been for a new drug, unrelated to the benzodiazepines and which is more specifically orientated towards anxiety. Buspirone, it seems, may well be such a drug. This paper discusses the anxiety disorders, the drug management of anxiety, the problems associated with traditional anxiolytics and the recent availability of a new class of drug in this indication.

Anxiety Disorders↗
PubMed1988

Identification of anatomically extensive coronary artery disease by the exercise ECG ST segment/heart rate slope.

To assess the ability of the ST segment/heart rate (ST/HR) slope to identify three-vessel coronary disease and the relationship between the ST/HR slope and the anatomic extent of disease as determined by the Gensini and Duke jeopardy scores, the exercise ECGs of 128 patients with stable angina were compared with findings at coronary cineangiography. A ST/HR slope greater than or equal to 6 microV/beat/min identified three-vessel coronary disease with a sensitivity of 93% compared with sensitivities of only 50% for early positive standard test responses (p less than 0.001) and 66% for markedly positive standard test responses (p less than 0.01). The negative predictive value of this ST/HR slope partition for three-vessel disease was 94%. Patients with ST/HR slopes greater than or equal to 6 who did not have three-vessel disease had anatomically more extensive obstruction than did patients with lower test values (mean Gensini score 43 +/- 5 vs 22 +/- 3, p less than 0.002 and mean jeopardy score 4.8 +/- 0.4 vs 3.0 +/- 0.3, p less than 0.01). Test performance of the calculated ST/HR slope exceeded that of a simplified index derived by dividing the total change in ST segment depression by the total change in heart rate. These findings demonstrate that a ST/HR slope greater than or equal to 6 is highly sensitive for the identification of three-vessel coronary disease and also identifies patients with anatomically severe obstruction. A ST/HR slope less than 6 makes three-vessel coronary disease or otherwise anatomically extensive coronary obstruction unlikely.

Adult↗
PubMed1986

Left atrial myxoma: diagnosis by digital subtraction intravenous angiography.

Digital subtraction intravenous angiography (DSIVA) represents an important technical advance in angiographic diagnosis. Herein we present three patients with left atrial myxoma assessed by DSIVA. We review the role of DSIVA in evaluation of patients with suspected cardiac tumors and the importance of careful atrial-phase scrutiny in examinations obtained for other purposes (ie, pulmonary angiography and assessment of ventricular function).

Angiography↗
PubMed1986

Diagnostic accuracy of coronary angiography utilizing computer-based digital subtraction methods. Comparison to conventional cineangiography.

To evaluate the efficacy of mask-mode digital subtraction angiography in selective coronary arteriography, we compared computer-based digital subtraction angiograms to standard film-based angiograms in 77 patients. Digital angiography was performed utilizing a 512(2) matrix and a framing rate of 30 frames/second. Radiation parameters were selected after a pilot dose-ranging trial, and were 70-120 KVP, 10-30mA and 0.8 to 5msec pulse width. Single view digital angiograms were compared to single view conventional angiograms in 27 patient; the two angiograms agreed within one grade of severity in 84 percent of the lesions or normal arteries seen. Multiple view digital angiograms were compared to multiple view conventional angiograms in 50 patients. Agreement within one grade of severity was found for 90 percent of lesions or normal arteries. Digital angiography detected 95 percent of collateral vessels seen on conventional angiography. We conclude that computer-based mask-mode digital subtraction angiography can be utilized in selective coronary angiography to obtain results comparable to those using conventional film-based cineangiography.

Adult↗
PubMed1985

Hemodynamic assessment of intravenous bepridil administration in ischemic heart disease.

The hemodynamic effects of intravenous administration of bepridil were evaluated in 17 patients with chronic coronary artery disease who underwent cardiac catheterization. Of the 17 patients, 8 received bepridil, 2 mg/kg of body weight, for 15 minutes followed by 1 mg/kg for 15 minutes (group A), and 9 received 3 mg/kg followed by 1 mg/kg (group B). In group A, the systemic blood pressure (BP) decreased (p less than 0.05) and left ventricular end-diastolic pressure increased minimally (p less than 0.05). Heart rate (HR), pulmonary artery pressure, cardiac output (CO), stroke index, pulmonary vascular resistance and systemic vascular resistance (SVR), stroke work index, "contractility" (+dP/dt) and double product (HR X systolic BP) showed no significant change after bepridil infusion. In contrast, in group B, while +dP/dt decreased (p less than 0.01), SVR also showed a strong downward trend and changed significantly more than in group A; in the context of the latter alteration, CO increased significantly. In addition, the double product (less than 0.025) and systemic BP (p less than 0.05) decreased, though other parameters did not vary significantly. Thus, although a modest dose-related negative inotropic effect (decreased +dP/dt) was seen, dose-related direct systemic vasodilatation (decreased SVR) led to improved cardiac performance (increase in cardiac index) at the larger dose.

Adult↗
PubMed1985

Improved accuracy of the exercise electrocardiogram: identification of three-vessel coronary disease in stable angina pectoris by analysis of peak rate-related changes in ST segments.

Exercise electrocardiography has relatively poor specificity and predictive accuracy for 3-vessel coronary artery disease (CAD) when conventional diagnostic criteria are used. However, electrocardiographic evaluation using linear regression analysis of the heart-rate (HR)-related change in ST-segment depression (ST/HR slope) is reported to accurately distinguish patients with from those without CAD, and to accurately separate patients with 1-, 2- and 3-vessel CAD. To assess the applicability of this method and to compare it with conventional interpretation, retrospective evaluation of 50 patients in whom exercise electrocardiography and coronary cineangiography had been performed for suspected CAD was conducted using a modified ST/HR slope analysis limited to leads V5, V6 and aVF. Eighteen patients had 3-vessel, 22 had 2-vessel, 6 had 1-vessel and 4 had no CAD. Standard electrocardiographic criteria (1 mm or more of horizontal or downsloping ST depression) identified 3-vessel CAD with a sensitivity of 78%, specificity of 56% and positive predictive value of only 50%. Peak ST/HR slope criteria (greater than or equal to 6.0 microV/beat/min) identified 3-vessel CAD with a sensitivity of 78%, specificity of 97% and positive predictive value of 93%. The overall test accuracy using measured peak ST/HR slope was 90%, compared with 64% for standard ST-depression criteria. In conclusion, analysis of the peak ST/HR slope can greatly improve the diagnostic accuracy of exercise electrocardiography, and further prospective study of this method is indicated.

Adrenergic beta-Antagonists↗
PubMed1985

Cardiac digital angiography: applications in ventriculography and coronary arteriography.

Clearly, computer-based digital subtraction offers several advantages over conventional approaches to contrast angiography. Using the newer method, in many situations contrast loads can be beneficially reduced, radiation exposure can be markedly diminished, and right ventricle evaluations can be simplified. In addition, storage of data on magnetic tape is less space consuming, and less costly, than storage on film. Over the 5- to 10-year life expectancy of a digitally equipped laboratory, these advantages probably justify the 30-50% increase in the initial monetary outlay for equipment in excess of that required for a conventionally equipped laboratory. However, the greatest promise of digital angiography is in the area of coronary arteriography. If three-dimensional reconstruction of coronary lesions and determination of regional flow can be effected, important advances in diagnosis and in prognostication theoretically might be expected, leading to more appropriate selection of therapy for individual patients than now can be achieved. However, currently available information does not yet indicate the extent to which such potential advantages will be realized. Thus, it will be several years before we will know whether the exciting potential of digital angiography in this area can be reached.

Angiography↗
PubMed1984

Hemodynamic effects of nifedipine versus hydralazine in primary pulmonary hypertension.

The acute hemodynamic effects of both sublingual nifedipine (N) and intravenous hydralazine (Hy) were studied in 5 patients with primary pulmonary hypertension to ascertain whether the capacity for pulmonary vasodilatation was generalized or drug-specific, and to determine which of the 2 agents had preferential pulmonary vasodilatory effects. For the group as a whole, neither N nor Hy produced changes in heart rate, mean pulmonary capillary wedge or right atrial pressures. Both N and Hy reduced mean systemic arterial pressure (before N 90 +/- 8 mm Hg, after N 76 +/- 7 mm Hg, p less than 0.01; before Hy 92 +/- 11 mm Hg, after Hy 68 +/- 8 mm Hg, p less than 0.05), and decreased systemic vascular resistance (before N 1,558 +/- 645 dynes s cm-5, after N 1,192 +/- 430 dynes s cm-5, p less than 0.05; before Hy 1,700 +/- 415 dynes s cm-5, after Hy 957 +/- 285 dynes s cm-5, p less than 0.05). In addition, N administration resulted in an increased cardiac output (before N 4.5 +/- 2.0 liters/min, after N 4.8 +/- 2.0 liters/min, p less than 0.01); Hy administration was associated with a more varied effect on cardiac output (before Hy 4.0 +/- 1.0 liters/min, after Hy 5.3 +/- 1.8 liters/min, p less than 0.10, difference not significant [NS]).(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Pressure↗
PubMed1984

Functional importance of coronary collateral vessels.

Angiographically demonstrable coronary collateral vessels are believed to preserve myocardial function at rest, but disagreement exists regarding the importance of collaterals in mitigating exercise-induced ischemic dysfunction. Therefore, we used radionuclide cineangiography during exercise to assess the left ventricular (LV) functional effects of collateral vessels in 125 patients with at least 1 major coronary artery that had greater than or equal to 90% diameter stenosis but without prior myocardial infarction. Regional LV function, graded on a 4-point scale, worsened during exercise by at least 1 grade in 14 of 43 regions (33%) with good collaterals, and in 70 of 98 without good collaterals (p less than 0.001). Of the 43 good collaterals, 14 were supplied by arteries with greater than or equal to 75% stenoses; 10 of 14 regions (71%) thus supplied worsened by at least 1 grade (p less than 0.01). The ischemia-mitigating effect of coronary collateral vessels also affected the magnitude of exercise-induced global dysfunction. Of 43 patients with only one greater than or equal to 90% stenotic artery, 18 had good collaterals; in these patients, average LV ejection fraction (EF) at rest was 51 +/- 8%; LVEF during exercise was 46 +/- 7%. In the 25 patients without good collaterals, LVEF at rest was 52 +/- 7%, and LVEF during exercise was 41 +/- 9% (p less than 0.005 vs good collaterals).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗