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Biomedical subjects

W H Goodson

Publications and source records attributed to W H Goodson.

At least 55 records · Page 3Linked to original sources
PubMed1986

The value of radiation therapy after excision of stage I breast cancer.

Most studies of the treatment of early breast cancer with conservative surgery and radiation therapy have had two major shortcomings: they have been based largely on short-term follow-up; and they have compared their short-term results only with long-term results after mastectomy. These methods greatly underestimate the actual incidence of local recurrence after breast preservation combined with radiation therapy because a significant portion (50% or more) of local recurrences after radiation treatment for early breast cancer are recognized more than five years after treatment. The effect of radiation is more accurately assessed by comparing results with conservative surgery without radiation therapy. This allows an estimate of the effect of the radiation therapy itself. Ten-year local recurrence rates after treatment of early breast cancer with mastectomy, conservative surgery with radiation therapy and conservative surgery without radiation therapy are 0-8%, 13-26% and 16-19% respectively. When breast preservation is combined with radiation therapy there is a lower incidence of local recurrence at five years, but at 10 years the results with and without radiation therapy are quite comparable. In both situations the recurrence rates are much higher than after mastectomy. The significance of this higher recurrence rate has not been fully evaluated. All reports of the treatment of early breast cancer should have at least 10 years of follow-up. Under no circumstances should any data be published which include patients followed for less than five years.

Breast Neoplasms↗
PubMed1985

What do breast symptoms mean?

Breast symptoms of pain, tenderness, and engorgement correlate with objective findings of nodularity on physical examination. Like all other factors for breast disease, they are not a single determinant of diagnosis, as shown by the 3 X 3 contingency table, but they are a useful addition to our understanding. From the available data, symptoms seem as accurate as physical examination for evaluating changes in benign diseases. By extrapolation, we expect they will be useful for management of premalignant breast lesions. We conclude that a complete breast evaluation should include inquiry about breast symptoms and whether these symptoms have changed.

Adult↗
PubMed1985

Comparison of fetal, newborn, and adult wound healing by histologic, enzyme-histochemical, and hydroxyproline determinations.

We compared simultaneous healing processes in fetal, newborn, and maternal rabbits using a miniaturized wound cylinder of expanded Gore-Tex tubing. The tubing was placed subcutaneously in fetal and maternal rabbits on day 23 of pregnancy (term = 31 to 32 days), and in 7-day-old newborn rabbits. At specific intervals, the tubing was removed and analyzed for hydroxyproline accumulation, histology, and cellular enzyme-histochemistry. Granulation tissue ingrowth and accumulation of hydroxyproline were each inversely related to age (fetus greater than newborn greater than maternal). The fetus showed an impressive infiltration of macrophages by day 4, fibroblasts by day 7, and a conspicuous lack of neutrophils in all specimens. Newborns and mothers had few cells until day 7, when a mixture of macrophages, neutrophils, and some fibroblasts appeared. We conclude that the fetus heals wounds rapidly by both mesenchymal cell proliferation and collagen deposition, and that these processes are more rapid in fetuses than in newborn or adult animals despite relative fetal hypoxemia.

Age Factors↗
PubMed1985

Vitamin E and benign breast "disease": a double-blind, randomized clinical trial.

We report here the results of a double-blind, randomized trial of the effect of vitamin E on clinically palpable benign breast findings. Seventy-three women who attended a breast screening clinic were assigned randomly to either a daily regimen of 600 IU vitamin E (n = 37) or a placebo (n = 36). At the initial visit sociomedical information was obtained for each patient and breast examination performed, with a score ranging from 0 to 4 recorded for each quadrant of both breasts. Thirty-two women in the vitamin E group and 30 in the placebo group returned for follow-up breast examination approximately 2 months later. Scores for mean ages and breast findings at entry were similar for women in the two groups. We found no differences between the vitamin E and placebo groups in scores for changes in breast findings at the end of the study period and no differences in the proportion of women who reported feeling less premenstrual pain (40.0% and 41.4%, respectively). We conclude that in this group of women with breast findings, most of which were not currently serious enough to warrant biopsy, there was no beneficial effect of vitamin E taken during a 2-month course.

Adult↗
PubMed1985

Prenatal child safety education.

In a prospective trial at two hospitals, 78 of 136 couples received a special 30-minute curriculum consisting of a lecture, a motion picture demonstrating the consequences of not using child car safety seats, and a question-and-answer session. Four to six months postpartum all parents were interviewed by telephone. When asked how their child rode during the most recent car trip, 96% of parents who received the special curriculum said they used a crash-tested child car safety seat, compared with 78% of those who had not received the curriculum. At hospital B, where parents reported demographic factors often associated with low compliance (eg, lower income, low use of seat belts, lower educational level), compliance rose from 60% before curriculum to 94% after curriculum (P less than .01). A car safety curriculum added to prenatal classes will increase parents' use of child car safety seats. Obstetricians and those managing prenatal care should assume a role in educating expectant parents about child passenger safety.

Accident Prevention↗
PubMed1984

Studies on inflammation and wound healing: angiogenesis and collagen synthesis stimulated in vivo by resident and activated wound macrophages.

Wound inflammatory cells were harvested by aspiration of fluid from the "dead space" of subcutaneous rabbit wounds and transplanted into the cornea where, compared with suitable controls, they stimulated healing (i.e., angiogenesis, fibroplasia, and new collagen synthesis, which led to formation of visible, vascularized scar tissue). Analysis of the data and the literature supports the conclusions that: (1) inflammatory cells control the continuation of the repair process after the immediate effects of injury subside; (2) macrophages, as opposed to granulocytes, appear to be the major contributors; (3) activated by their presence in the wound, macrophages release substances that stimulate fibroplasia, collagen synthesis, and angiogenesis in vivo; and (4) tissue injury is not a maximum stimulus to repair, since endotoxin-treated macrophages have increased capacity to stimulate collagen synthesis and angiogenesis. A hypothesis is offered to explain the notorious clinical discrepancy between the extent of injury and the extent of repair.

Animals↗
PubMed1983

Fine-needle aspiration of palpable breast masses. A program for staged implementation.

Fine-needle aspiration (FNA) can provide a morphologic diagnosis of palpable breast masses in an accurate, efficient, inexpensive, and safe manner. However, how one acquires the skill to perform the FNA and interpret the resulting smears, while protecting the patient from the risk of false-positive or false-negative results, is scarcely considered. We used a three-phase program to acquire experience with FNA while providing services for 205 patients over a 16-month period. We performed FNA sequentially in vitro, in vivo, and finally in vivo for clinical use. With available literature and this graduated implementation program, physicians totally inexperienced with FNA can achieve results similar to those of medical centers having experience with thousands of patients.

Biopsy, Needle↗
PubMed1983

Mammography after needle aspiration of palpable breast masses.

Hematoma resulting from attempted aspiration of a palpable breast mass can cause incorrect mammographic interpretation by rendering irregular and indistinct the otherwise smooth and sharply defined margins characteristic of a benign lesion. In this study of recently aspirated breast masses, we found 17 benign lesions that demonstrated poorly defined, irregular margins on mammograms that suggested malignancy. All these false-positive interpretations occurred when aspiration preceded mammography by less than 2 weeks (17 of 47, 36 percent); no such diagnostic error occurred in the 31 cases when mammography was delayed for 2 weeks or more after aspiration. An appreciation of the frequency and natural history of postaspiration hematoma formation should either encourage physicians to request mammography before carrying out invasive procedures, or alternatively, to defer mammography until 2 weeks after aspiration, since mammography then should more clearly portray the benign characteristics of truly benign masses, thereby possibly obviating biopsy.

Biopsy, Needle↗
PubMed1983

Continuous direct tissue oxygen tension measurement by a new method using an implantable silastic tonometer and oxygen polarography.

A new method of tissue oxygen tension measurement that is suitable for human use has been described. An implanted Silastic tube tonometer is combined with polarographic oxygen electrodes. The techniques of preparation, insertion, and measurement have been described. The advantages and disadvantages of this method have been considered in relation to established methods of tissue oxygen tension measurement. The method is suitable for clinical use and can be used to aid clinical decision-making.

Oxygen↗
PubMed1983

Direct measurement of wound and tissue oxygen tension in postoperative patients.

An implanted Silastic catheter technique was used to measure partial pressure of oxygen in mastectomy wounds and needle-induced wounds in the subcutaneous tissue of the arms of 33 postoperative patients to assess tissue-wound oxygenation and perfusion on the day of operation and daily through postoperative day five. Characteristic patterns were observed. Wound hypoxia was common and most pronounced after abdominal, vascular, and cardiac procedures. It was most severe immediately after operation. Tissue hypoxia was not easily detected by clinical evaluation and was unknowingly tolerated by experienced surgeons. The relationship between arterial and tissue PO2 is biphasic and presumably curvilinear at the lower range of PaO2 and rises linearly even above the point of full saturation of hemoglobin. Supplemental bolus fluid infusion elevated depressed tissue PO2 in 19 out of 19 measurements, implicating hypovolemia as a common cause of postoperative tissue hypoxia. Measurements of tissue oxygen tension, coupled with a single arterial oxygen determination, constitute a clinically useful means of monitoring tissue perfusion.

Abdomen↗
PubMed1982

Development of a new miniature method for the study of wound healing in human subjects.

A new miniaturized method for evaluation of healing potential in human subjects has been developed. A small, standardized, subcutaneous wound is made in a standard location. Expanded PTFE tubing is placed in the wound and removed at specific intervals. The ingrowth of connective tissue is evaluated by histology and by measurement of hydroxyproline accumulation. Beginning on the fifth day, hydroxyproline accumulation correlates with visual accumulation of tissue in the tubing. Preliminary results show decreased hydroxyproline accumulation in the wounds of patients with preoperative debility. This is to be expected on the basis of previous clinical experience and laboratory studies. This method has the further advantage that the catheters may be placed with local anesthesia in outpatients and therefore may be applied systematically to populations, as well as for observation in patients requiring operation.

Animals↗
PubMed1982

Role of platelets and fibrin in the healing sequence: an in vivo study of angiogenesis and collagen synthesis.

UNLABELLED: The signals that initiate repair are poorly characterized. These studies investigate the capacity of platelets and fibrin to initiate angiogenesis, fibroplasia, collagen synthesis and monocyte migration in the rabbit cornea assay. METHODS: Autologous platelets and platelet-free fibrin were isolated from rabbit blood. Released and control platelet preparations and autologous and commercial fibrin were implanted in rabbit corneas. RESULTS: Thrombin-released platelets produced angiogenesis and opacification. Histology showed fibroplasia, corneal thickening, and neovascularization. Collagen synthesis was elevated to twice control levels in thrombin-activated platelet preparations. Various control platelet preparations produced no angiogenesis, no opacification, and no histologic change. All fibrin injections elicited a cellular exudate from the limbal vessels, followed by angiogenesis and corneal opacification. Histology showed a mononuclear infiltrate with neovascularization and fibroplasia. Control injections of rabbit skin collagen and fibroblasts produced no response.

Animals↗
PubMed1982

Effects of caffeine-free diet on benign breast disease: a randomized trial.

There is considerable interest in the potential effect on benign disease of a diet free of methylxanthines (caffeine, theophylline, and theobromine) found in coffee, tea, colas, and chocolate. We randomly assigned 158 women who presented with a breast concern either to a group encouraged to abstain from methylxanthine-containing foods and beverages or to a group who received no dietary recommendations (controls). At the initial visit each patient's sociomedical history and data on methylxanthine consumption were obtained by interview, and clinically palpable breast findings were graded on a scale of 0 to 4 (no nodularity to confluent hard "dysplasia") for each quadrant of both breasts. On the follow-up visit approximately 4 months later similar information was obtained. Mammograms were taken at both visits for a subset of women in each group. We found a statistically significant reduction in clinically palpable breast findings in the abstaining group as compared with controls, but the absolute change was minor and may be of little clinical significance. Comparison of before-after mammograms offered little support for the methylxanthine hypothesis. There was no relation between clinically palpable breast finding scores at initial examination and caffeine consumption levels reported at that time.

Adult↗
PubMed1979

Deficient collagen formation by obese mice in a standard wound model.

Poor healing was demonstrated in two different experimental models of diabetes mellitus. In one model, there was an absolute lack of insulin and in the other, a resistance to insulin. A review of the history of the results of surgery in diabetic patients shows that in the clinical situation, wound failure is associated with both a lack of insulin and a resistance to insulin. Thus, the causes of wound failure in diabetic patients include a failure of insulin to perform its normal role in healing. This does not exclude other causes such as "small vessel disease" as etiologic factors, but it does suggest that control of metabolic derangements is beneficial to healing in diabetic patients who undergo operation.

Animals↗
PubMed1979

Wound healing and aging.

There are "natural delays" in the healing of older individuals. Open wounds contract more slowly and incised wounds gain strength more slowly. Experimental studies indicate that cellular proliferation, wound metabolism, and collagen remodeling occur later in old animals. Clinical studies show, however, that operations can be performed safely in elderly patients and that the major increased risk to these patients is of nonwound medical complications that affect the wound.

Age Factors↗