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Biomedical subjects

M Goldberger

Publications and source records attributed to M Goldberger.

At least 19 recordsLinked to original sources
PubMed2000

Impact of thrombolysis, intra-aortic balloon pump counterpulsation, and their combination in cardiogenic shock complicating acute myocardial infarction: a report from the SHOCK Trial Registry. SHould we emergently revascularize Occluded Coronaries for cardiogenic shocK?

OBJECTIVES: We sought to investigate the potential benefit of thrombolytic therapy (TT) and intra-aortic balloon pump counterpulsation (IABP) on in-hospital mortality rates of patients enrolled in a prospective, multi-center Registry of acute myocardial infarction (MI) complicated by cardiogenic shock (CS). BACKGROUND: Retrospective studies suggest that patients suffering from CS due to MI have lower in-hospital mortality rates when IABP support is added to TT. This hypothesis has not heretofore been examined prospectively in a study devoted to CS. METHODS: Of 1,190 patients enrolled at 36 participating centers, 884 patients had CS due to predominant left ventricular (LV) failure. Excluding 26 patients with IABP placed prior to shock onset and 2 patients with incomplete data, 856 patients were evaluated regarding TT and IABP utilization. Treatments, selected by local physicians, fell into four categories: no TT, no IABP (33%; n = 285); IABP only (33%; n = 279); TT only (15%; n = 132); and TT and IABP (19%; n = 160). RESULTS: Patients in CS treated with TT had a lower in-hospital mortality than those who did not receive TT (54% vs. 64%, p = 0.005), and those selected for IABP had a lower in-hospital mortality than those who did not receive IABP (50% vs. 72%, p < 0.0001). Furthermore, there was a significant difference in in-hospital mortality among the four treatment groups: TT + IABP (47%), IABP only (52%), TT only (63%), no TT, no IABP (77%) (p < 0.0001). Patients receiving early IABP (< or = 6 h after thrombolytic therapy, n = 72) had in-hospital mortality similar to those with late IABP (53% vs. 41%, n = 64, respectively, p = 0.172). Revascularization rates differed among the four groups: no TT, no IABP (18%); IABP only (70%); TT only (20%); TT and IABP (68%, p < 0.0001); this influenced in-hospital mortality significantly (39% with revascularization vs. 78% without revascularization, p < 0.0001). CONCLUSIONS: Treatment of patients in cardiogenic shock due to predominant LV failure with TT, IABP and revascularization by PTCA/CABG was associated with lower in-hospital mortality rates than standard medical therapy in this Registry. For hospitals without revascularization capability, a strategy of early TT and IABP followed by immediate transfer for PTCA or CABG may be appropriate. However, selection bias is evident and further investigation is required.

Aged↗
PubMed1997

Successful intracoronary thrombolysis in cocaine-associated acute myocardial infarction.

We describe a case of cocaine-associated acute myocardial infarction managed by cardiac catheterization and intracoronary thrombolysis. Based on this and other reported cases, it appears that an invasive approach to the management of cocaine-associated acute myocardial infarction is advantageous over intravenous thrombolysis. Such a strategy would define the pathophysiology of acute myocardial infarction in the setting of cocaine use and allow mechanical intervention should pharmacologic therapy be unsuccessful.

Adult↗
PubMed1996

Urologic injuries in pelvic ring disruptions.

Pelvic ring disruptions are the result of high energy blunt trauma and are associated with other significant injuries in greater than 50% of the cases. These injuries may involve neurovascular structures and other organ systems. Lower urinary tract injuries may occur in as much as 25% of patients with pelvic ring disruptions. Coordinated care between the orthopaedist and urologist is required for successful treatment of the urologic and pelvic injury. Of primary importance to the orthopaedist is the potential for infection after open stabilization of the anterior arch. When contaminated urine communicates with the anterior arch, the possibility of infection exists. Early repair of bladder disruptions with simultaneous anterior arch plating minimizes this risk. The treatment of urethral disruptions and the safest method for urinary drainage remain controversial, however.

Fractures, Closed↗
PubMed1995

Enactment and play following medical trauma. An analytic case study.

This paper on the four-year analysis of a five-year-old girl with a school phobia details the playroom enactments of medical trauma and its sequelae. Early in the analysis the patient expressed herself almost exclusively through play. Gradually she connected her conflicts, including those over her compulsive masturbation, to her hospital experiences. Only after the traumatic medical experiences were no longer the major issue did other important conflicts become available for analytic work. Physical activity remained prominent in the analysis and generated pressure for mutual enactment. This case again draws our attention to the complex overlap of play, enactments, and verbalization in child analysis.

Child, Preschool↗
PubMed1995

The couch as defense and as potential for enactment.

Use of the couch in psychoanalysis is almost universal because of its many advantages. This paper focuses on situations in which the use of the couch is not beneficial, involving problems of the patient or of the analyst. Interferences with the usefulness of the couch are illustrated by means of vignettes from the analysis of four patients which demonstrate the isolating potential of the couch and the reasons why this may make the couch appeal to some patients and repel others. The distancing potential of the couch may sometimes appeal to analysts, particularly when the face-to-face arrangement is troublesome. The use of the couch for the enactment of conflict is discussed, as are analytic attitudes toward the use or non-use of the couch.

Adult↗
PubMed1993

The use of an audiotaped analysis in a continuous case seminar.

The use of an audiotaped analysis in a continuous case seminar is evaluated. We compare this case seminar to the traditional one in which an analyst presents process notes, and find that the use of the tape lends itself readily to teaching microanalysis, principles of technique, and observation of affect. Listening to anonymous taped sessions allowed for the possibility of a freer climate for discussion, as none of the seminar participants had a personal relationship with the taped analyst. The disadvantages posed by the absence of the analyst during the seminar also are addressed.

Curriculum↗
PubMed1992

Active skeletal muscle mass and cardiopulmonary reserve. Failure to attain peak aerobic capacity during maximal bicycle exercise in patients with severe congestive heart failure.

BACKGROUND: In addition to depressed cardiac reserve, peripheral factors may contribute to limit maximal exercise capacity in patients with congestive heart failure (CHF). To investigate the role of reduced active skeletal muscle mass, peak oxygen uptake (VO2, milligrams per kilogram per minute) was determined during maximal symptom-limited exercise involving the lower limbs (LL) alone and the lower limbs and upper limbs (LL+UL) combined in patients with CHF and in normal subjects of similar age and sex. METHODS AND RESULTS: LL bicycle exercise was performed upright with a ramp protocol and continuous expired gas analysis. When respiratory exchange ratio (RER) reached 1.0, UL exercise was initiated at constant load with the use of a cranking device positioned at shoulder level. LL exercise alone and combined LL+UL exercise were performed on separate days in randomized order by 24 patients with CHF and seven normal subjects. In patients with CHF, peak VO2 was greater during combined LL+UL exercise than during LL exercise alone, i.e., 15.8 +/- 0.8 versus 14.2 +/- 0.9 ml.kg-1.min-1 (p < 0.001), whereas in normal subjects, maximal VO2 was similar during the two tests, i.e., 26.7 versus 26.2 ml.kg-1.min-1 (NS). The increase in peak VO2 during combined LL+UL exercise relative to LL exercise alone was almost exclusively observed in patients with peak VO2 < 15 ml.kg-1.min-1 (mean increase, 21.7 +/- 4.1%). Peak VO2 during combined LL and UL exercise did not increase relative to LL exercise alone in patients with peak VO2 > 15 ml.kg-1.min-1 and in normal subjects of similar age and sex, i.e., 0.1 +/- 4.0% and 2.0 +/- 2.3% respectively. CONCLUSIONS: In contrast to normal subjects and patients with moderate CHF, patients with severe CHF do not exhaust their cardiopulmonary reserve during symptom-limited maximal LL exercise on a bicycle.

Exercise Test↗
PubMed1991

Research on teaching in physical education: a commentary on Silverman's review.

This commentary discussed the need for a clearer definition of teaching. Silverman's RT-PE schema was reviewed, and several concerns were raised. Clark's framework for conceptualizing research methods for teaching was reviewed. And, finally, the Spectrum of Teaching Styles was suggested as a schema for organizing RT-PE content. Silverman's review has enriched our discipline, and he deserves our appreciation. In particular the breadth of his review is noteworthy. This review should be useful to teachers and should serve as a catalyst for further discussion in the research community about this interesting and important discipline.

Behavior↗
PubMed1991

Pregnancy during analysis--help or hindrance?

This paper challenge the technical precept that during pregnancy a woman is less accessible to analytic treatment. The precept, which originated more than fifty years ago, has remained with us despite significant changes in our knowledge about pregnancy; despite fundamental changes in analytic theory with attendant changes in technique; and despite a large body of clinical evidence to which this paper contributes further information from four analytic cases. All of these developments support the view that pregnancy is not a contraindication for analysis but, on the contrary, can facilitate analytic progress.

Adult↗
PubMed1989

On the analysis of defenses in dreams.

This paper deals with a particular analytic approach to the clinical use of dreams: the analysis of defenses in dreams. Clinical vignettes are used to demonstrate various ways that defenses can be depicted in dreams and the manner in which the patient's attention may be drawn to those defenses. Dreams can offer an especially vivid view of defenses and hence can heighten patients' emotional conviction about the nature of their conflicts.

Defense Mechanisms↗
PubMed1986

Clinical experience with intra-aortic balloon counterpulsation in 112 consecutive patients.

Intra-aortic balloon pumping (IABP) was attempted in 112 consecutive patients, resulting in successful placement in 49 of 50 (98%) patients when the percutaneous technique was used and in 60 of 62 (97.3%) patients when the surgical technique was used. Complications following acute myocardial infarction and perioperative problems were the two most frequent (47% and 52%, respectively) indications for IABP. A favorable survival was observed in patients with acute myocardial infarction with ventricular septal defect undergoing surgery after IABP (80%) and in patients in whom IABP was used in the perioperative setting (57.6%); survival remained poor in patients with postinfarction shock or severe heart failure (20% and 23%, respectively). Complications related to IABP occurred in 23 (20.5% patients but tended to occur more frequently in patients undergoing placement by the percutaneous route than by the surgical route (31% vs 9.6%; p less than 0.03) and in patients over age 70. Thus IABP can be successfully inserted in the majority of patients, but the high complication rate, especially with the percutaneous route, suggests caution in its indiscriminate use, particularly in patients whose mortality remains high despite its use.

Adult↗
PubMed1985

On transference manifestations in male patients with female analysts.

The transference issues that are specific to the psychoanalysis of male patients by female analysts have not been widely discussed in the literature. Most of the literature on this subject has indicated, contrary to the findings reported here, that full and intense erotic transference manifestations are rarely if ever seen in this therapeutic dyad. In order to clarify the issues, we have offered some definitions that may serve as a framework for future discussions. We have utilized clinical examples from the psychoanalyses of five patients to illustrate certain aspects of the transference. We have demonstrated that male patients display a full range of erotic transference phenomena with female analysts and have focused attention on certain special features of these tranferences. For example, in some cases it was only after considerable analysis of defences against aggression that the erotic transference manifestations emerged fully. We have also shown that paternal transferences occur regularly, though they may be difficult to elucidate until the later stages of analysis. We have paid special attention to the feared loss of maleness that attends male patients' identification with their female analysts.

Adult↗
PubMed1983

Kawasaki syndrome in an adult: endomyocardial histology and ventricular function during acute and recovery phases of illness.

Kawasaki syndrome, an acute systemic inflammatory illness of unknown origin usually affecting children, may develop into a serious illness complicated by coronary artery aneurysms or myocarditis. This report describes an adult with Kawasaki syndrome studied by right ventricular endomyocardial biopsy and cardiac catheterization during the acute and recovery phases of illness. The initial biopsy specimen showed acute myocarditis and was associated with hemodynamic evidence of biventricular dysfunction, a severely depressed left ventricular ejection fraction and global hypokinesia. With time, there was spontaneous and rapid resolution of the inflammatory cell infiltrate with concurrent return to normal myocardial function. Right ventricular endomyocardial biopsy studies early in the course of the cardiac disease associated with Kawasaki syndrome may correlate with ventricular function and may be useful for monitoring immunosuppressive therapy in patients with this syndrome.

Adult↗