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Biomedical subjects

M P Goldman

Publications and source records attributed to M P Goldman.

At least 19 recordsLinked to original sources
PubMed1992

Physicians' negative perception of sclerotherapy for venous disorders: review of a 7-year experience with modern sclerotherapy.

Sclerotherapy is the injection of a sclerosing substance directly into a varicosity or telangiectasia to cause damage, fibrosis, and eventual obliteration of the vessel. Although sclerotherapy has been shown to be effective with a low incidence of side effects, many physicians in the United States are unaware of the technique or view it in a negative way. To better define the extent of physician unfamiliarity or prejudice toward sclerotherapy, we surveyed a local medical community of gynecologists by anonymous written questionnaire. The results indicated that 82% of the responding physicians believed that their knowledge of sclerotherapy was insufficient to advise their patients, leaving patients to learn about sclerotherapy from mass media sources. Sclerotherapy was perceived as only slightly effective therapy for varicose veins and was thought to have a relatively high incidence of side effects. With recent improvements in the technique, our collaborative experience with 3000 patients receiving 50,000 injections over the past 5 years has shown that sclerotherapy is a safe procedure achieving outstanding cosmetic results with concomitant symptomatic relief of painful varicosities and telangiectases. Sclerotherapy, as practiced today, offers an effective, simple, and less costly alternative to surgical stripping for most varicose and telangiectatic veins. The survey data demonstrate the need to educate the American medical community about the technique and merits of modern sclerotherapy so that patients may be properly guided by their physicians to the best sources of care for their aching and unsightly leg veins.

Adolescent↗
PubMed1992

Postsclerotherapy hyperpigmentation. Treatment with a flashlamp-excited pulsed dye laser.

Seventeen patients with 22 areas of postsclerotherapy hyperpigmentation lasting from 1 to 7 years were treated with a flashlamp-excited pulsed dye laser at 510 nm with a pulse duration of 300 nanoseconds between 2 to 3 J/cm2. Depth of hemosiderin pigmentation ranged from 0.2 to 2.8 mm. Forty-five percent of lesions lightened after treatment with significant lightening occurring in 27% of lesions. Four lesions in two patients developed postinflammatory hyperpigmentation after treatment. There was no significant difference in treatment response to pigment location or laser energy.

Humans↗
PubMed1991

The depth of thermal necrosis using the CO2 laser: a comparison of the superpulsed mode and conventional mode.

In order to compare the depth of thermal necrosis on human skin using the superpulse CO2 laser to the conventional CO2 laser, single impacts of various laser settings were fired at both ends of fusiform excisions done for other clinical purposes. These laser impacts were then examined histologically and the superpulse mode was found to limit the depth of thermal necrosis by approximately a factor of two.

Dermatologic Surgical Procedures↗
PubMed1991

A comparison of sclerosing agents. Clinical and histologic effects of intravascular sodium morrhuate, ethanolamine oleate, hypertonic saline (11.7%), and sclerodex in the dorsal rabbit ear vein.

The dorsal marginal rabbit ear vein was injected with 0.25 mL of 2.5, 1, or 0.5% sodium morrhuate, 2.5, 1, or 0.5% ethanolamine oleate, hypertonic saline 11.7%, or Sclerodex. Only the vessel injected with 2.5% sodium morrhuate demonstrated clinical and histologic evidence of endosclerosis with microangiopathic recanalization; 2.5% ethanolamine oleate demonstrated partial clinical sclerosis and luminal recanalization histologically. All other evaluated solutions except 0.5% ethanolamine oleate produced immediate clinical and histologic endothelial damage and thrombosis. However, these latter solutions did not produce sufficient endothelial damage to cause endosclerosis. Extravasated red blood cells occurred in vessels injected with 1 and 2.5% ethanolamine oleate and 1 and 2.5% sodium morrhuate at 1 hour and 2 days, but not in vessels injected with sodium morrhuate 0.5%, ethanolamine oleate 0.5%, Sclerodex, or hypertonic saline 11.7%. Hemosiderin discoloration was not apparent clinically. Cutaneous necrosis was not observed with any of the evaluated solutions.

Animals↗
PubMed1990

Pulsed dye laser treatment of telangiectases with and without subtherapeutic sclerotherapy. Clinical and histologic examination in the rabbit ear vein model.

The treatment of leg telangiectases with the carbon dioxide or argon laser results in a low success rate and an unacceptable risk of scarring. Sclerotherapy is effective; however, pigmentation and telangiectatic matting induced by extravasation of RBCs and excessive posttreatment inflammation are common. We conducted a clinical and histologic study of therapy with the 585 nm pulsed dye laser alone and in combination with subtherapeutic sclerotherapy in the rabbit ear vein model. The pulsed dye laser alone was effective when 10 joule/cm2 was used. In combination with immediate injection of the sclerosant, effective endosclerosis occurred with all tested laser energies (8 to 10 joule/cm2).

Animals↗
PubMed1990

A comparison of sclerosing agents: clinical and histologic effects of intravascular sodium tetradecyl sulfate and chromated glycerin in the dorsal rabbit ear vein.

The dorsal marginal rabbit ear vein was injected with 0.25 ml of 0.1% or 0.25% sodium tetradecyl sulfate (STS) (Sotradecol Injection) or undiluted or 50% Scleremo (Scl) (chromated glycerin). Only the 50% Scl solution failed to produce clinical or histologic thrombosis at 1 hour. Clinical fading was observed in STS-treated vessels at 10 days postinjection. Histologically, early thrombus formation with focal endothelial necrosis was replaced by fibrosis and microangiopathic recanalization. Although undiluted Scl caused similar, yet milder histologic findings, luminal recanalization after 10 days resulted in a clinically unfaded vessel. The use of 50% Scl produced no endothelial damage with no subsequent change in vessel appearance. Cutaneous necrosis or extravasation of erythrocytes was not observed.

Animals↗
PubMed1990

Compression in the treatment of leg telangiectasia: a preliminary report.

The use of postsclerotherapy compression was evaluated in 37 women with bilaterally symmetrical telangiectatic leg veins. Compressed vessels tended to achieve a greater clinical resolution when located on the distal leg and/or when greater than 0.5 mm in diameter. Postsclerotherapy hyperpigmentation fell from 40.5% to 28.5% with the use of compression. In addition, ankle and calf edema were lessened if a graduated compression stocking was worn immediately after sclerotherapy.

Adult↗
PubMed1990

Pulsed-dye laser treatment of leg telangiectasia: with and without simultaneous sclerotherapy.

Thirty consecutive female patients with red leg telangiectasia less than 0.2 mm in diameter were treated with a Candela SPTL-1 Pulsed Dye Laser (PDL) tuned to 585 nm with a pulse duration of 450 microseconds at energies ranging from 6.0 to 8.5 J/cm2 delivered through a 5-mm spot size to the entire length of the telangiectasia. Seven patients with 25 patches of telangiectatic matting after previous sclerotherapy were also treated. Twenty-seven patients with symmetrical telangiectatic patches or a large "starburst" telangiectatic flair that could be divided into two separate treatment sites were treated at one site with PDL alone, and at the other site with a combination of PDL followed immediately by sclerotherapy (SCL) with Polidocanol 0.1-0.25 ml per injection site at a concentration of either 0.25%, 0.5%, or 0.75%. PDL treatment is efficacious for both essential telangiectasia and vessels that arise through the phenomena of telangiectatic matting. Sixty-five percent of vessels are completely faded with treatment. PDL alone has a remarkably low incidence of adverse sequelae. Treatment is most efficacious if all vessels larger than 0.2 mm in diameter, especially varicose and reticular feeding veins, are treated first. Treatment results are not affected by vessel location. And post-treatment compression of this type of vessel appears unnecessary. Combination PDL/SCL treatment appears to offer no advantage to sclerotherapy treatment alone and has a significant degree of complications when treatment is limited to red telangiectasia less than 0.2 mm in diameter with the laser parameters utilized.

Adult↗
PubMed1990

Ciprofloxacin drug utilization review and prospective drug use evaluation.

Ciprofloxacin is a fluoroquinolone antimicrobial with activity against both gram-negative and -positive bacteria including pseudomonal and staphylococcal species. It is the only available oral agent possessing this unique spectrum of activity that achieves serum concentrations adequate to treat a variety of systemic infections. A retrospective drug utilization review and a prospective drug use evaluation of ciprofloxacin were performed to determine if the agent was being used for appropriate indications, to ensure correct dosing and appropriate monitoring, and to determine whether its use is cost effective at the Veterans Administration Medical Center, Cleveland (VAMCC). For the retrospective review, 40 patients' charts were randomly chosen for review from computerized inpatient and outpatient prescription records. Drug use review criteria were developed by the Pharmacy Service and Infectious Disease Section. For the prospective evaluation, data were collected for all inpatient and outpatient requests for ciprofloxacin during a six-month period (May to November 1988) using the same criteria as in the retrospective study. Cost analysis was performed by identification and cost comparison of alternative therapy and by estimating the number of days saved by using appropriate oral therapy. All charts from the retrospective review were found to meet criteria for appropriate use. All patients for whom documented follow-up was performed had microbiologic or clinical cures. In the prospective evaluation, 168 patients were started on ciprofloxacin. Ninety-five percent of patients had appropriate justification for use according to criteria. Drug cost savings for the six-month period was +14,962.54 or +29,925.08/year. This covered drug and minibag acquisition costs only. An estimated 127 hospital days were saved (shortened length of +71,717.00 or +143,434.00/year.(ABSTRACT TRUNCATED AT 250 WORDS)

Bacterial Infections↗
PubMed1990

Vancomycin-associated exfoliative dermatitis.

We describe a 51-year-old patient with endstage renal disease who developed vancomycin-associated exfoliative dermatitis. After four weeks of vancomycin hydrochloride treatment for staphylococcal pericarditis this patient developed a hypersensitivity reaction characterized by intermittent fevers, lymphadenopathy, peripheral eosinophilia, and exfoliative dermatitis. The reaction persisted for five weeks, probably because of inability to rapidly eliminate vancomycin secondary to underlying renal failure. Maculopapular rashes have been reported in two to six percent of patients who receive this drug, with severe skin reactions rarely reported. In addition to this case report, a review of the literature including 11 Eli Lilly/Food and Drug Administration case reports is presented. Although severe skin reactions to vancomycin rarely occur, they prolong morbidity, particularly in patients with renal failure.

Dermatitis, Exfoliative↗
PubMed1989

Anatomy and pathophysiology of varicose veins.

The venous anatomy of the leg is described with special reference to the superficial venous system. The histologic and histochemical differences between varicose and normal veins are presented. The pathophysiology of varicose veins is related to congential or acquired abnormalities of the deep venous system, venous valves, and/or fascial or vein wall weakness. Increased deep venous pressure may be both proximal and distal in etiology, arising from arteriovenous anastomoses, incompetent communicating veins, or venous obstruction. Primary valvular incompetence arises from venous obstruction (thrombosis), thrombophlebitis, or valvular agenesis. Secondary valvular incompetence occurs from deep venous obstruction or increased venous distensibility (usually secondary to circulating estrogens). Finally, fascial weakness of the vein wall or supporting fascia provided a genetic basis for the pathophysiology of varicose veins. Understanding the anatomy and pathophysiology of varicose veins should lead to a more rational and efficacious treatment.

Elastic Tissue↗
PubMed1989

Compression in the treatment of leg telangiectasia: theoretical considerations.

Unwanted leg veins are a common affliction of men and women. They may be either varicose and symptomatic or telangiectatic and of mostly cosmetic concern. Since patients wishing cosmetic improvement commonly present for treatment, one should utilize a technique that produces the least number of adverse sequelae. The use of compression in performing sclerosing treatment for varicose veins produces 5-year follow-up results similar to surgical treatments. This article presents theoretic reasons for advocating the use of compression in the treatment of all blood vessels, whether telangiectatic or varicose.

Adult↗
PubMed1988

Tattoo removal with minimal scarring: the chemo-laser technique.

A method useful in the removal of decorative tattoos too large for simple excision, or tattoos located in anatomic areas prone to hypertrophic scarring, is described. The method employs the carbon dioxide (CO2) laser for partial ablation of the tattooed area, followed by the repeated application of a urea mixture to complete the removal of the dyes. (These applications continue until the wound is totally healed.) Results indicate that even in areas that typically develop hypertrophic scarring, such as the upper chest, breast, and upper arm, this technique can effectively remove over 95% of the pigment and leave a perfectly flat scar.

Cicatrix↗
PubMed1988

The role of calcium channel blocking agents in the prevention of migraine.

Vascular headache pathophysiology and manifestations are reviewed along with the role that calcium channel blocking agents play in prevention of these vascular headaches. Of the calcium channel blockers presently marketed in the U.S., verapamil has been the most widely studied. Verapamil has been shown to produce a significant improvement in frequency and duration of migraine as compared with placebo. Calcium channel blocking agents that have been studied and used outside of the U.S. are flunarizine and nimodipine, both of which provide significant improvement in measures of migraine severity, duration, frequency, and other pain and severity indices. There have been no controlled trials comparing these agents with each other as with beta-blocking agents and other prophylactic agents presently marketed in the U.S. Calcium channel blocking agents may become the drugs of first choice in migraine prophylaxis due to their effectiveness and mild side effect profile.

Calcium Channel Blockers↗