Biomedical subjects

J Goldberg

Publications and source records attributed to J Goldberg.

At least 19 recordsLinked to original sources

PubMed1992

Versatile use of skin expanders in facial plastic surgery.

Large soft-tissue resection defects of the face and scalp present an arduous technical problem for the facial plastic surgeon. Successfully matching tissue coverage with similar skin color and texture is usually limited by the amount of available local skin. Also, the need to limit distortion of fixed anatomic sites when harvesting local skin must be addressed. With the advent and utilization of soft-tissue expanders, the availability of local skin is increased and anatomic distortions are limited. This article describes the versatile use of skin expansion in facial plastic and reconstructive surgery. Expansion techniques include long-term expansion for scalp and cervicofacial defects. Acute intraoperative expansion techniques address repair of perioral, labial, and nasal mucosal lining defects. The success, limitations, and complications of these techniques are reviewed.

Adolescent↗

PubMed1992

Elementary methods for the analysis of dichotomous outcomes in unselected samples of twins.

This paper presents an elementary statistical method for analyzing dichotomous outcomes in unselected samples of twin pairs using stratified estimators of the odds ratio. The methodology begins by first randomly designating one member of each twin pair as an "index" twin and the other member as the "co-twin." Stratifying on zygosity, odds ratios are used to measure the association between disease in the index twin and disease in the co-twin. From these zygosity-specific tables we calculate the Woolf-Haldane estimator of the common odds ratio (psi F, the weighted average of the zygosity-specific odds ratios), the Mantel-Haenszel test statistic (chi 2M-H) for the common odds ratio, and a test (chi 2G) for the difference in the zygosity-specific odds ratios. In this application, psi F provides an estimate of the familial association for disease and the accompanying chi 2M-H provides a test of the null hypothesis, psi F = 1 (i.e., there is no evidence for a familial influence on disease). The chi 2G is a test of the null hypothesis that psi MZ = psi DZ; a significant value for chi 2G suggests a genetic influence on disease (assuming that the observed odds ratios follow a pattern where psi MZ greater than psi DZ). A new test statistic (chi 2c) is proposed that incorporates the expectation that psi MZ = psi 2DZ under a purely additive genetic model with no common environmental effects. A significant value of chi c2 indicates that the different odds ratios across zygosity are partly due to common environmental influences. Conversely, a nonsignificant value of chi 2c is an indication that the zygosity-specific odds ratios are due solely to additive genetic effects and not to common environment. This basic approach is extended to examine the effects of measured indicators of the specific environment and the assessment of certain forms of gene by environment interaction. All of the methods are easily understood, highly flexible, readily computed using a hand calculator, and incorporate the inherent genetic information contained within twin samples.

Data Interpretation, Statistical↗

PubMed1992

Hepatic cavitation. A marker of transient hepatocellular injury during biliary lithotripsy.

Sonographically visible microbubbles attributable to cavitation effects have been observed in bile (within the gallbladder), in hepatic vessels, and within the liver of patients undergoing biliary lithotripsy. Cavitation effects are believed to contribute to stone fragmentation and possibly tissue injury during lithotripsy. To study the latter, the relationship between intraparenchymal hepatic cavitation and serum transaminase activity and clinical follow-up was analyzed in 81 patients undergoing 164 lithotripsy treatments. Seventy-one treatments (43%) resulted in sonographically evident microbubbles in the liver parenchyma during lithotripsy. A temporary, yet statistically significant (P < 0.01) rise in SGOT and SGPT was observed within 2 hr of completion of lithotripsy compared to those patients without hepatic microbubbles. All but one patient had a return to pretreatment baseline levels of SGOT and SGPT by two weeks after lithotripsy. In this patient, persistent elevation of transaminases was attributed to the delayed passage of fragments and not to any sequelae from hepatic cavitation effects. Ultrasound immediately after, two weeks after, and 3-12 months after lithotripsy showed no hepatic structural abnormalities. Ursodiol administration at the time of treatment did not predispose to hepatic cavitation or elevation of transaminase. Detection of hepatic microbubbles during lithotripsy is a marker of hepatocellular injury. Their correlation with transaminase elevation refutes the contention that transaminasemia results solely from fragment passage after lithotripsy. Although not associated with recognizable structural damage or long-term sequelae, cavitation effects and transaminasemia reiterate that shockwaves are not entirely benign as they traverse parenchymal organs.

Alanine Transaminase↗

PubMed1992

Preadmission anaesthesia consultation clinic.

Many surgical procedures are delayed or cancelled due to inadequate preoperative assessment and preparation. We describe the case referral pattern and efficiency of our preadmission anaesthesia consultation clinic, which was designed to minimize this problem. Data were collected prospectively on the first 400 patients referred to the clinic. Sixty per cent of referrals were related to the cardiovascular system, in particular coronary artery disease (27%). Eighty-one per cent of referrals were considered appropriate. With ideal functioning of the clinic, delays and cancellations could potentially be reduced to 0.75% and 1.5% of cases respectively. The clinic was well accepted and appreciated by patients. We conclude that this represents a potential important reduction in hospital costs and improvement in operating room efficiency.

Ambulatory Surgical Procedures↗

PubMed1992

The case of a newspaper phobia in a 9-year-old child.

The case of E, a 9-year-old, male, with a newspaper phobia, is presented. The phobia developed over a 4-year period and gradually spread until it included many significant areas of E's life. Treatment took place over a 4-month period. It involved use of a token economy administered by E's parents. Cognitively, the treatment involved the concepts of the acquisition of perceived self-control as a consequence of the token economy agreement. This included volition, attention, and self-control by E as well as parental reinforcement.

Behavior Therapy↗

PubMed1992

c-myc and c-myb expression in acute myelogenous leukemia.

Monoclonal antibodies and flow cytometry were used to detect the expression of c-myc and c-myb in the bone marrow (BM) and peripheral blood (PB) cells of patients with acute myelogenous leukemia (AML). The expression of neither gene was correlated with the percent blast cells in the BM or PB nor was there a correlation between c-myc and c-myb expression. A wide range of expression of each gene was found within each FAB type of AML. Patients who had a high proportion of leukemia cells expressing c-myb were less likely to respond to remission induction therapy than patients in whom a low proportion of cells expressed c-myb. This association appears to reflect an inverse relationship between the proportion of cells expressing c-myb and the sensitivity of leukemia cells to the killing effects of chemotherapy in vivo. Treatment outcome was unrelated to c-myc expression.

Bone Marrow↗

PubMed1992

The effects of the Le Fort I osteotomy on the periodontium.

Two age-matched populations of equal size (n = 40), one having orthodontic therapy and the other combined orthodontic therapy and orthognathic surgery, were evaluated for their periodontal status 1 to 10 years posttherapy. The parameters investigated were plaque index, gingival index, tooth mobility, width of keratinized tissue, probing depth, gingival recession, and attachment level. No significant differences were found (P less than .05). Within the surgery group, patients with maxillary osteotomies segmentalized between the central incisors (n = 11) and between the canines and second premolars (n = 12) were evaluated using the same parameters and compared with their nonsegmental counterparts. No significant differences were found for patients with osteotomies segmentalized between the central incisors. However, a statistically significant increase in probe depth and loss of attachment level of up to 0.3 mm was found at the sites of osteotomies segmentalized between the canine and second premolar (P less than .05). This difference was not considered clinically significant.

Adolescent↗

PubMed1992

A comparison of clinical examination, history, and magnetic resonance imaging for identifying orthodontic patients with temporomandibular joint disorders.

The temporomandibular joint (TMJ) status of 51 juvenile orthodontic patients was assessed with magnetic resonance imaging (MRI), clinical examination, and questionnaire data. The results of this study demonstrated that the prevalence of anterior displacement of the meniscus was 11.8% (6 of 51) as assessed by MRI. Clicking or pain in the TMJ area was found in 9.8% (5 of 51) of the subjects by clinical exam, and 19.8% (10 of 51) of the subjects had a history of pain or clicking of the TMJ. Three subjects had a positive MRI and a negative history and clinical examination. However, all subjects with positive MRI findings had a history of other risk factors known to be associated with TMJ internal derangement (TMJ-ID). Therefore practitioners should use a history form and a clinical examination technique that includes a broad range of signs and symptoms of temporomandibular disorders (TMD) to identify patients who may have abnormal condyle disk relationships and be at risk for TMD. Clicking and pain in the TMJ helped identify only one half of the patients with abnormal condyle-disk relationships in this study population. Future cephalometric studies will monitor the effects of abnormal condyle disk relationships on facial growth during orthodontic treatment.

Adolescent↗

PubMed1992

The association between water fluoridation and hip fracture among white women and men aged 65 years and older. A national ecologic study.

For the past 45 years, there has been a great deal of debate regarding the health issues surrounding the fluoridation of public water supplies. In order to assess the association between fluoridation and hip fracture, we identified 129 counties across the United States considered to be exposed to public water fluoridation and 194 counties without exposure. Data from the Health Care Financing Administration and the Department of Veterans Affairs were used to calculate the incidence of hip fracture among white persons, aged 65 years or older, in fluoridated and nonfluoridated counties. There was a small statistically significant positive association between fracture rates and fluoridation. The relative risk (95% confidence interval) of fracture in fluoridated counties compared to nonfluoridated counties was 1.08 (1.06 to 1.10) for women and 1.17 (1.13 to 1.22) for men. As comparisons were made at the grouped level, it may be inappropriate at this time to draw inferences at the individual level. The relationship observed at the county level needs to be duplicated at the individual level with more precise measures of fluoride exposure.

Aged↗

PubMed1992

Health effects of military service. Lessons learned from the Vietnam experience.

This article examines the methodologic difficulties encountered in studies of the long-term effects of the Vietnam War on the psychological and physical health of veterans. Alternate study designs and exposure and outcome measurements are examined in relation to psychological (post-traumatic stress disorder and alcohol use or abuse) and physical (mortality and birth defects in children) health outcomes. All major epidemiologic studies of post-traumatic stress disorder and alcohol use or abuse utilize cross-sectional research designs. Mortality and birth defect studies use cohort, case-control, or proportionate mortality strategies. Exposure is measured using either definitive dichotomous indicators of service in Southeast Asia or more complex indicators of the Vietnam experience (i.e., combat, herbicide exposure, atrocities, abusive violence) that are of suspect validity. In studies of psychological health, outcomes are based exclusively on self-reported symptoms, while investigations of mortality and birth defects use death certificates and hospital records. Epidemiologic research on the effects of the Vietnam conflict has been hampered by problems in research design and the inherent difficulties of measuring wartime exposures and long-term health outcomes.

Alcoholism↗

PubMed1992

The effect of two intensities of massage on H-reflex amplitude.

The purposes of this study were (1) to investigate the effectiveness of two different levels of massage on the depression of spinal motoneuron excitability (as demonstrated by peak-to-peak H-reflex amplitude changes), (2) to investigate the presence of any gender effects in relation to massage, and (3) to describe a method used to quantify the amount of pressure exerted during two different intensities of massage. Two levels of massage were quantified and defined as light massage (LM) and deep massage (DM). These levels of massage corresponded to pressures of 1.25 and 2.50 kPa (5 and 10 in H2O), respectively. The therapist, before beginning the investigation, was trained to deliver these pressures. Ten peak-to-peak H-reflex recordings were elicited from the triceps surae muscle of each of 20 neurologically healthy subjects (10 male, 10 female) (mean age = 22.6 years) during five control and the two massage conditions. Each condition was 3 minutes in duration. Significant differences were found among the resulting means. The peak-to-peak H-reflex amplitudes recorded during the DM condition were reduced in comparison with those recorded during the LM condition. The peak-to-peak H-reflex amplitudes during both massage conditions were reduced in comparison with those recorded during the control conditions. These changes were noted against a stable M-response. This suggests that the mechanism involved in the observed inhibitory response is pressure sensitive, with DM bringing about a greater inhibitory response than did LM. No differential effects attributable to gender differences were found. These results will serve to define massage characteristics in an ongoing study investigating the effect of massage in persons with a spinal cord injury.

Adult↗

PubMed1992

Hospitalization with vertebral fracture among the aged: a national population-based study, 1986-1989.

Whereas fractures related to osteoporosis have become a pressing public health concern, relatively few epidemiologic studies have focused on vertebral fractures. To shed further light on the occurrence of this injury, we collected data from the Health Care Financing Administration on 151,986 discharges listing a diagnosis of vertebral fracture over a 4-year period. After adjusting for age, white women experienced the highest rates of discharge, at 17.1 per 10,000 per year, followed by white men (9.9 per 10,000), black women (3.7 per 10,000), and black men (2.5 per 10,000). Among white women, discharge rates rose exponentially from 5.3 discharges per 10,000 population at age 65 to nearly 47.8 per 10,000 at age 90. White men, black women, and black men experienced less dramatic age-related increases in discharge rates. The similarity of these patterns to discharge rates for hip fracture suggests that the race-sex differences in vertebral fracture discharge rates may be due to differences in the incidence of vertebral fracture.

Aged↗

PubMed1992

The selective use of AMSA following high-dose cytarabine in patients with acute myeloid leukaemia in relapse: a Leukemia Intergroup study.

This clinical trial was designed to evaluate the role of high-dose cytarabine (ara-C) in the treatment of adults with acute myeloid leukaemia (AML) in first relapse. We also tested the hypothesis that the selective use of AMSA (100 mg/m2/d on days 7, 8 and 9) would increase the complete remission (CR) rate when leukaemia cells remained in the bone marrow immediately following 6 d of Ara-C (2-3 g/m2/12 h) alone. Of 155 patients evaluable for response, 115 (74%) experienced marked cytoreduction by day 6 and received no further induction chemotherapy; 53 (45%) of these patients achieved CR after one course and 45 (38%) had resistant disease. The 36 patients (23%) with inadequate cytoreduction after the 6 d of ara-C alone were randomly assigned either to no further chemotherapy (21 patients) or to 3 d of AMSA (15 patients). The CR rates after one course were 14% and 53%, respectively (P = 0.01), and the fractions with resistant disease were 76% and 40%, respectively. The fractional reduction of leukaemia cells in the day 6 bone marrow aspirate specimen (P < 0.0001) and the reduction in the leukaemia cell mass measured in the day 6 marrow biopsy (P = 0.001) were the strongest predictors for achieving CR versus having residual disease in univariate analyses. The median duration of remission was 5 months, but seven patients (10%) remain in CR after 30-92 + months. Among the 140 patients who received only the 6 d of ara-C, the pretreatment albumin (P = 0.002) and lactate dehydrogenase (P = 0.01) levels were the strongest predictors of response in univariate analyses, but only the albumin remained significant (P = 0.01) in a stepwise logistic regression analysis. Those patients with albumin > 4.0 mg/dl and LDH < 125% of normal had a 71% CR rate, and only 16% had resistant disease. Thus, pretreatment characteristics and rapid cytoreductin in the day 6 bone marrow sample identified a favourable subset of patients with AML in first relapse, some of whom responded quite well to 6 d of ara-C alone and have had long disease-free remissions.

Acute Disease↗

PubMed1992

Phase II trial of 7-day continuous 5-fluorouracil infusion in the treatment of advanced colorectal carcinoma.

Thirty-eight patients with advanced colorectal adenocarcinoma were entered on a phase II trial of 5-fluorouracil (5-FU) in continuous infusion, using a portable pump. Half of the patients had been pretreated (n = 19) and 16 of them had received intravenous bolus 5-FU alone or in combination. At the first cycle patients received continuous intravenous 5-FU at the dose of 650 mg/m2 per day for 7 consecutive days. Doses were escalated during the following cycles and adjusted according to the toxicities encountered in the previous cycle. Treatment was repeated every 3 weeks. A mean dose of 750 mg/m2/day (500-1,000) was administered for a mean number of 10 (1-25) cycles. We observed 1 complete response, 7 partial responses for a response rate of 21 +/- 13% (CI95%), 16 had stable disease (42%) and 14 a progression (37%). In 2 patients subsequently the residual tumors could be excised after chemotherapy. Median survival was 13.5 months. Toxicity was: grade 2 leukopenia in 1 patient (3%), mucositis grade 2-4 in 11 patients (29%), diarrhea grade 2-3 in 7 patients (18%), and hand and foot syndrome in 12 patients (31%). There was a correlation between the mean dose administered and the responses. However no clear correlation was found between toxicity and tumoral response for the first two cycles. These results confirm the limited efficacy of continuous intravenous 5-FU and its good tolerance in ambulatory patients.

Actuarial Analysis↗

PubMed1992

Insect lipophorin conversions. Compositional analysis of high- and low-density lipophorin of Acherontia atropos and Locusta migratoria.

The formation of low-density lipophorin (LDLp) in insect hemolymph, resulting from association of high-density lipophorin (HDLp) with both lipid and apolipophorin III, is considered to provide a reutilizable lipid shuttle for flight muscle energy supply. The changes in lipid and apolipoprotein composition of LDLp, isolated after flight activity, compared to that of HDLp in the hemolymph at rest, were studied in two evolutionary divergent insects, the hawkmoth Acherontia atropos and the migratory locust, Locusta migratoria. Using FPLC on Superose 6 prep grade as a novel technique to separate the apolipophorins of HDLp and LDLp, the ratio of apolipoprotein I, II, and III in HDLp of both species was demonstrated to be 1:1:1, whereas flight activity resulted in a ratio of 1:1:10 in LDLp. Injection of adipokinetic hormone into resting moths showed that, depending on the dose, the number of apolipophorin III molecules in LDLp can exceed that recovered after the physiological condition of flight. Analysis of the lipophorin lipids demonstrated that in addition to the considerable increase in diacylglycerol in the LDLp particle, which is consistent with the role LDLp in energy supply, particularly the hydrocarbons were increased compared to HDLp, rendering the mechanism of LDLp formation from HDLp even more complex.

Animals↗

PubMed1992

Race and sex differences in mortality following fracture of the hip.

This paper describes the all-cause mortality experience, following a fracture of the hip, of 712,027 persons covered by the Medicare program from 1984 through 1987. White women experienced the lowest mortality rate (17.2 per 1000 person-months), followed by Black women (22.9 per 1000 person-months), Black men (33.5 per 1000 person-months), and White men (33.7 per 1000 person-months). The observed race-sex differences in survival were found at all ages and regardless of the number of comorbid conditions listed with the discharge diagnosis. While these data demonstrate marked race-sex differences in survival following hip fracture, the cause of these differences is not immediately apparent and demands further investigation.

Aged↗

PubMed1992

Large granular lymphocytosis terminating in a polymorphous B-lymphocytic proliferation after low-dose cyclophosphamide therapy: a case report with necropsy findings.

A 70-year-old man presented with clonal large granular lymphocytosis of T-suppressor/cytotoxic immunophenotype, neutropenia, paraproteinemia, and proneness to infection. The patient became severely leukopenic during 14 days of chemotherapy with low-dose cyclophosphamide, and remained so after discontinuation of the drug. Clinically, he was thought to have prolonged chemotherapy-induced marrow hypoplasia. At death, 16 days after the last dose of chemotherapy, autopsy confirmed bone marrow hypoplasia and revealed that well-differentiated, polymorphous, and (immunophenotypically and genotypically) polyclonal B-lymphocytes predominated in normal hematopoietic and lymphoid organs. A similar lymphoid infiltrate was intimately associated with multiple ulcers and smooth muscle necrosis in the stomach. These terminal findings resemble B-lymphoproliferative conditions described in certain forms of immune deficiency.

Aged↗

PubMed1992

Relationship of [3H]Ara-C incorporation and response to therapy with high-dose Ara-C in AML patients: a Leukemia Intergroup study.

Pretherapy bone marrow (BM) aspirates of 143 patients with acute myeloid leukemia (AML) were incubated simultaneously with bromodeoxyuridine (BrdU) and tritiated cytosine arabinoside ([3H]Ara-C) to determine the labeling index (LI) and extent of [3H]Ara-C incorporation. Of 143 AML patients, 121 received high-dose Ara-C (HDAra-C) as a single agent for induction therapy (55 newly diagnosed, 66 in first relapse), whereas 22 received HDAra-C plus mAMSA. The data demonstrate that a subset of patients who will fail HDAra-C remission induction therapy because of drug-resistant disease can be prospectively identified on the basis of the low amount of Ara-C incorporated by their leukemia cells.

Acute Disease↗