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Biomedical subjects

J D Goodson

Publications and source records attributed to J D Goodson.

27 records · Page 2Linked to original sources
PubMed1976

Bilateral adrenalectomy of lambs in utero: effects on maternal hormone levels at induced parturition.

Progesterone, 17 alpha, 20 alpha-dihydroxypregn-4-en-3-one, androstenedione, total unconjugated oestrogen and oestrone sulphate have been measured by radioimmunoassays in maternal utero-ovarian venous, maternal peripheral venous and/or foetal posterior vena caval plasma from six sheep bearing bilaterally adrenalectomized lambs, in which premature parturition was induced by administration of glucocorticoid. Three of the ewes were overiectomized, and in one of these three animals the foetal testes were also excised, at the time of foetal adrenalectomy. Adrenalectomy was judged to be complete on the basis of plasma cortisol levels in the neonatal lambs, and by examination of the site of ablation at necropsy. In all cases foetal administration of glucocorticoid led to the onset of labour, and lambing, and in all animals the hormonal changes preceding parturition were indistinguishable (either qualitatively or quantitatively) from the changes observed in animals carrying intact lambs. Since therapy with glucocorticoid alone successfully compensates for ablation of the foetal adrenal cortex, it is suggested that glucocorticoid is the only adrenal product required to cause parturition, and that foetal adrenal secretion of androgens may be unnecessary.

17-alpha-Hydroxypregnenolone↗
PubMed1975

Increased concentrations of 17alpha, 20alpha-dihydroxypregn-4-en-3-one in maternal and foetal plasma near parturition in sheep.

Using specific radioimmunoassays, 17alpha,20alpha-dihydroxypregn-4-en-3-one and progesterone were measured in maternal utero-ovarian venous plasma from four sheep during parturition induced with dexamethasone and two sheep at spontaneous delivery. 17alpha,20alpha-Dihydroxypregn-4-en-3-one was also measured in maternal jugular venous and foetal posterior vena caval plasma from one dexamethasone-induced animal over the same period. Basal utero-ovarian venous levels of 17alpha,20alpha-dihydroxypregn-4-en-3-one were in the range 3-7 ng/ml; at the time of the pre-labour fall in maternal progesterone, the concentration of 17alpha-20alpha-dihydroxypregn-4-en-3-one increased, reaching 17-76 ng/ml at delivery. Maternal levels fell rapidly after delivery. In contrast to foetal progesterone concentrations, which are low, foetal 17alpha,20alpha-dihydroxypregn-4-en-3-one levels were approximately the same as those in the maternal utero-ovarian vein. Maternal jugular venous levels in one animal were 50-80% of those in the utero-ovarian vein. These findings confirm earlier results obtained in vitro which indicated that exposure to glucocorticoid results in increased activity of a steroid 17alpha-hydroxylase in the ovine foetal placenta.

17-alpha-Hydroxypregnenolone↗
PubMedDate not supplied

Discomfort and disability in upper respiratory tract infection.

Ambulatory patients with upper respiratory infection were studied to determine the relative contributions made by tissue pathology, psychologic and perceptual attributes, and demographic characteristics to reported discomfort and disability. Patients (n = 115) attending a medical walk-in clinic completed self-report questionnaires to assess somatization, anxiety, depression, hostility, amplification, discomfort, disability, and demographic characteristics. Clinicians rated the extent of disease apparent on physical examination. Using stepwise multiple regression, demographic factors and physical findings explained 25% of the variance in reported discomfort. The addition of somatization scores increased the variance explained to 49%. The best model, including somatization and amplification, accounted for 54% of the variance. A model composed of demographic characteristics, physical findings, and somatization accounted for 25% of the variance in reported disability. The authors conclude that psychologic variables are important in the experience of discomfort, even after the extent of physical disease and demographic characteristics have been taken into account.

Activities of Daily Living↗
PubMedDate not supplied

The limited clinical value of home urine testing by diabetic patients.

To investigate the value of home urine glucose testing in assessing chronic diabetic glucose control, the authors compared patients' glycosuria patterns with their mean blood glucose (MBG) levels calculated from glycosylated hemoglobin (Hb Alc). One hundred and twenty-one patients who regularly checked their urines reported on the frequencies of glycosuria over the preceding ten weeks. There was substantial overlap in the glycosuria patterns of patients at different levels of MBG. Glycosuria was not detectable in only 44% of patients with good control (MBG less than or equal to 150 mg/dl). The probability of such good control given no glycosuria was only 26%. Similarly, frequent glycosuria was reported by only 27% of patients with poor control (MGB greater than 250 mg/dl). The probability of such poor control given frequent glycosuria was only 34%. Because home urine testing cannot reliably identify good or poor control, it has a very limited role in assessing patients' chronic glucose control.

Adolescent↗
PubMedDate not supplied

Do resident and staff physicians differ in the types and costs of antihypertensive drugs they select?

OBJECTIVE: To compare the types and costs of drugs prescribed by resident and staff physicians treating patients with uncomplicated essential hypertension. DESIGN: Cross-sectional study, using a computer-based medical record database. SETTING: Primary care internal medicine clinic in a large teaching hospital. PATIENTS/PARTICIPANTS: Hypertensive patients seen by ten postgraduate year-1 (PGY-1) and PGY-2 primary care internal medicine residents and four staff physicians practicing in the same clinic. MEASUREMENTS AND MAIN RESULTS: The types and costs of antihypertensive drugs prescribed for the patients treated by resident and staff physicians were compared. A larger proportion of patients of resident physicians than of staff physicians were treated with calcium channel blockers [19(15%) vs. 40(4%), p less than 0.001]; residents prescribed thiazide diuretics less frequently and beta-blockers more frequently than did staff physicians, although these differences were not significant. The estimated average wholesale price of antihypertensive drugs for patients cared for by residents was 35% higher than that for patients cared for by staff physicians ($0.73 vs. $0.54, p = 0.048). This difference was not fully explained by differences in practice composition. CONCLUSIONS: Resident physicians in this study selected more expensive medications to treat hypertension than did their faculty preceptors, even when differences in practice composition were considered.

Antihypertensive Agents↗
PubMedDate not supplied

Is upper gastrointestinal radiography necessary in the initial management of uncomplicated dyspepsia? A randomized controlled trial comparing empiric antacid therapy plus patient reassurance with traditional care.

STUDY OBJECTIVE: To compare two strategies for the evaluation and management of patients who have had acute dyspepsia for four days or more: empiric high-dose antacid therapy combined with patient reassurance (empiric care) versus therapy based on prompt upper gastrointestinal radiography (traditional care). DESIGN: Prospective, randomized trial. The patients in the empiric care group were reassured that upper gastrointestinal radiography was not necessary and were subsequently treated with high-dose empiric antacid therapy (15-30 ml of high-potency antacid one and three hours after meals and at bedtime). The traditional care group after meals and at bedtime). The traditional care group received upper gastrointestinal radiography as part of the initial evaluation. Subsequent treatment was determined by individual physicians based on test results. SETTINGS: Fee-for-service, hospital-based primary care practice and Veteran's Administration medical center outpatient clinic. PATIENTS: All patients were less than 70 years of age and without gastrointestinal bleeding, anemia, significant weight loss, or other specified symptoms of severe acid peptic disease. Fifty patients were randomized to traditional care, and 51 to empiric care. Pre-randomization clinical features were identical with the exception of sex distribution and baseline disability. MEASUREMENTS AND MAIN RESULTS: After six months of follow-up, there were no significant differences in symptom scores, disability, satisfaction, and quality of life measures (as measured by the Sickness Impact Profile scores) between the two groups. Findings were unchanged when adjusted for sex, study site, alcohol consumption, and cigarette smoking. Of the radiographs obtained in the traditional care group, 13 (27%) showed duodenal ulcer disease, gastritis, or duodenitis. There were no serious complications of ulcer disease or therapy noted in either group. The average costs per patient associated with traditional care at one study site were greater, $286 versus $116 (p less than 0.0001). CONCLUSIONS: Select patients with dyspepsia receiving a combination of reassurance and empiric antacid therapy do as well as patients whose initial management strategy includes upper gastrointestinal radiography, at a substantially lower cost.

Adult↗
PubMedDate not supplied

Empiric antacids and reassurance for acute dyspepsia.

The evaluation of ambulatory patients with dyspepsia frequently includes upper gastrointestinal radiographs (UGIs), a practice of unproven value in low-risk patients. To assess an alternative management strategy without UGIs, 28 patients with upper abdominal pain seen in an adult medical walk-in practice were treated with high-dose antacid therapy for three weeks. The clinical course on antacid therapy was good; 68% of patients reported substantial improvement. Initial requests for UGIs were high among both patients and physicians. Following empiric antacid therapy, requests for UGIs fell from 68% to 32% for patients (p = 0.05) and from 71% to 21% for physicians (p = 0.001). No serious complications were detected after 18 months of follow up. Direct medical charges were reduced by 37%. Empiric antacid therapy for patients at low risk for serious disease relieves dyspepsia and reduces both patient and physician requests for UGIs.

Adult↗
PubMedDate not supplied

The amplification of somatic symptoms.

We studied the role of somatosensory amplification, as measured by a self-report questionnaire, in symptomatology, overall discomfort, and disability in 115 patients with upper-respiratory-tract infections who visited an adult medical walk-in clinic. Multiple regression analyses indicated that amplification was a statistically significant predictor of the patients' localized but not systemic symptoms, of reported overall discomfort, and of their social and vocational disability. These relationships held true while controlling for differences in medical morbidity and sociodemographic characteristics. Amplification was closely related to, but distinct from, three measures of dysphoria: depression, anxiety, and hostility. The tendency to amplify a broad range of bodily sensations may therefore be an important factor in experiencing, reporting, and functioning with an acute and relatively mild medical illness.

Adult↗