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Goldberg A, Shapiro M, Hammel I, Mekori YA. Cutaneous responses to histamine, compound 48/80 and codeine in patients with hyperthyroidism. ANNALS OF ALLERGY 1990; 64:179-81. [PMID: 2306020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The regulatory effects of various endocrine factors on allergic processes have been widely studied. The clinical importance of hyperthyroidism in asthma and in chronic urticaria has been demonstrated in several cases. These observations may be attributed to modulatory effects of thyroid hormones on mast cell releasability and/or on other target organs as blood vessels. To evaluate the effects of thyroid hormones on mast cell releasability and on the cutaneous vasculature, we analyzed the wheal and flare response to compound 48/80, to codeine, and to histamine in patients with hyperthyroidism and in a control group. No significant difference was found between the two groups. We could not demonstrate any in vivo effect of the thyrotoxic state on the cutaneous response to these substances.
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227
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Goldberg A. Towards European medicine: an historical perspective. The FitzPatrick lecture 1988. JOURNAL OF THE ROYAL COLLEGE OF PHYSICIANS OF LONDON 1989; 23:277-86. [PMID: 2685270 PMCID: PMC5387602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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228
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Nevins A, Goldberg A. Wesley Hall: A Special Life. THE GERONTOLOGIST 1989. [DOI: 10.1093/geront/29.5.719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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229
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Goldberg A. Self psychology and the narcissistic personality disorders. Psychiatr Clin North Am 1989; 12:731-9. [PMID: 2798203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
This article is about the self psychological approach to narcissistic personality disorders. Starting from the vantage point of considering the growth and development of the self as crucial to understanding any and all disorders of narcissism, it describes the various forms of self development. These forms are felt to emerge and grow according to patterns seen in the transference of these patients in treatment. The transferences are called selfobject transferences and are based on the use of another person as part of the self, that is, as a part of the structure needed for growth. The three kinds of transferences that have been described are the mirror transference, the idealizing transference, and the twinship transference. These are considered to be expressions of childhood development that has gone awry and thus to be the focus for psychological intervention. Short-term treatment aims for repair of an injured or traumatized self. Long-term treatment or analysis aims for a reorganized self that pursues its own further development. Some factors involving etiology and the role of empathy in treatment are noted in the discussion.
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230
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Abstract
A double-blind study comparing placebo and haem arginate was conducted in 12 patients with acute intermittent porphyria. 2 days after admission in attack patients were randomised to receive intravenous haem arginate 3 mg/kg per 24 h for 4 days or placebo. 9 patients were readmitted with a further attack and were given the alternative treatment. Before randomisation the paired attacks were of similar severity with respect to urinary porphobilinogen (PBG) excretion and clinical manifestations. With haem arginate the median PBG excretion of the 9 patients with two attacks (normal range 0-16 mumol per 24 h) fell significantly from 332 mumol per 24 h (range 137-722) on admission to a median lowest level of 40 (range 22-105). On placebo, median PBG excretion was 382 (range 196-542) on admission, falling to 235 (range 128-427). Median duration of admission after the start of treatment was 11 days (range 2-28) for placebo and 8 days (3-26) for haem arginate. Median total analgesic requirement between the start of treatment and discharge was 8150 mg pethidine equivalents (range 0-17,650) with placebo versus 6425 (range 50-20,650) with haem arginate. Phlebitis occurred in 5 patients on haem arginate and in 2 on placebo. Haem arginate effectively reduces porphyrin precursor overproduction in the acute porphyric attack but this reduction is not accompanied by striking resolution of the clinical manifestations of the attack.
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231
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Mekori YA, Baram D, Goldberg A, Klajman A. Inhibition of delayed hypersensitivity reactions in mice by colchicine. I. Mechanism of inhibition of contact sensitivity in vivo. Cell Immunol 1989; 120:330-40. [PMID: 2524275 DOI: 10.1016/0008-8749(89)90201-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Colchicine has been recently shown to inhibit delayed hypersensitivity reactions (DHR). In the present study we investigated the effects of colchicine on contact sensitivity (CS) to dinitrofluorobenzene. Colchicine, at a dosage level of 15 micrograms/mouse, inhibited the elicitation of the contact response only when given on the day of ear challenge. Administration of the drug during the induction phase did not have any effect on the CS reaction. By using adoptive transfer experiments, we could demonstrate that CS was suppressed only when colchicine was given to the recipient mice, while treating the donors of immune lymph node cells (I-LNC) did not affect their ability to transfer a significant DHR. These findings were observed also when I-LNC were directly injected into the ears, a result which indicated that there was no effect of the drug on the ability of effector cells to migrate to the site of antigen challenge. Neither was there any effect on the distribution of T cell subsets in peripheral lymph nodes. The proliferative response of LNC to antigenic or mitogenic stimulation in vivo or in vitro was also not affected by colchicine pretreatment. These findings raise major questions about the mechanism of action of colchicine in vivo and suggest that more experimentation is required to probe the mechanism of colchicine-induced suppression of DHR.
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232
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Katzel L, Drinkwater D, Busby MJ, Lakatta L, Fleg J, Kramer J, Goldberg A, Hopkins J. HIGH DENSITY LIPOPROTEIN SUBSPECIES ARE LOW IN AEROBICALLY CONDITIONED ELDERLY MEN WITH ASYMPTOMATIC POSITIVE EXERCISE STRESS TEST. Med Sci Sports Exerc 1989. [DOI: 10.1249/00005768-198904001-00693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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233
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Drinkwater D, Busby J, Coon P, Lakatta L, Fleg J, Goldberg A. LEANNESS NOT FITNESS IS ASSOCIATED WITH HIGHEST LEVELS OF HIGH-DENSITY LIPOPROTEINS IN MASTER ATHLETES. Med Sci Sports Exerc 1989. [DOI: 10.1249/00005768-198904001-00673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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234
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Herrick AL, McColl KE, Moore MR, Brodie MJ, Adamson AR, Goldberg A. Acute intermittent porphyria in two patients on anticonvulsant therapy and with normal erythrocyte porphobilinogen deaminase activity. Br J Clin Pharmacol 1989; 27:491-7. [PMID: 2497768 PMCID: PMC1379729 DOI: 10.1111/j.1365-2125.1989.tb05398.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
1. Acute intermittent porphyria (AIP) is sometimes termed a 'pharmacogenetic' disease. patients with genetic deficiency of the enzyme porphobilinogen deaminase are liable to develop acute attacks of porphyria if exposed to a variety of drugs. 2. Two patients are reported who had no evidence of deficiency of erythrocyte porphobilinogen deaminase yet developed typical attacks of AIP while on anticonvulsant therapy. 3. Normal activity of erythrocyte porphobilinogen deaminase does not completely exclude porphyria. 4. Acute porphyria should be suspected if clinical deterioration occurs during therapy with anticonvulsants, or other porphyrinogenic drugs, even in the absence of an underlying genetic defect in haem synthesis in peripheral blood cells.
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235
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Cottrell E, Powell S, Meyers D, Coon P, Bleecker E, Goldberg A. WEIGHT LOSS AND EXERCISE TRAINING IMPROVES CARDIOVASCULAR AND METABOLIC RISK FACTORS FOR CORONARY ARTERY DISEASE IN OBESE OLDER MEN. Med Sci Sports Exerc 1989. [DOI: 10.1249/00005768-198904001-00295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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236
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Abstract
1. The neurotoxic effect of lead on the catecholaminergic and cholinergic nervous systems has been investigated using a rat model of lead exposure. 2. This model of lead exposure resulted in significant quantities of lead accumulating in the blood, brain and femur of the lead-exposed animals. 3. The biochemical effect of lead on brain neurochemistry was dependent on the degree and duration of lead exposure. However, the data points to a selective action of lead, with the midbrain and diencephalon being prime targets while very few lead-related alterations were observed in the cerebellum or the telencephalon. 4. Within the catecholaminergic nervous system, lead exposure resulted in alterations in the concentrations of the transmitters, noradrenaline and dopamine, in addition to changes in the activities of the enzymes tyrosine hydroxylase and phenylethanolamine-N-methyl transferase. The activity of the cholinergic biosynthetic enzyme, choline acetyltransferase was also noted to be altered by lead exposure.
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237
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Goldberg A. Tuberculosis and breast cancer: case report and review. THE MOUNT SINAI JOURNAL OF MEDICINE, NEW YORK 1988; 55:421-7. [PMID: 3063959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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238
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Goldberg A, Reisman RE. Prolonged interval maintenance venom immunotherapy. ANNALS OF ALLERGY 1988; 61:177-9. [PMID: 2458060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Current guidelines recommend indefinite administration of venom immunotherapy at 4-week intervals. To simplify this therapy, we examined the clinical and immunologic response after extending the interval between maintenance venom injections to 6, 8, and 12 weeks. Twenty-six patients who had had sting anaphylaxis and positive skin tests received maintenance bee or yellow jacket venom immunotherapy at greater or equal to 6-week intervals. This extended interval was started after a prior average 4-week maintenance interval of 2.3 years. Injections were given at 6-week intervals to all 26 patients and extended to 8-week intervals in 10, and 12-week intervals in 3 patients. Following venom injections, there were 14 mild local reactions and no systemic reactions. No adjustment in dosing was necessary. While on prolonged interval maintenance venom immunotherapy, there were 17 re-stings in 12 patients with no systemic reactions. During prolonged interval maintenance venom immunotherapy, either the serum venom-specific IgG increased or the already elevated titers remained the same in 18 patients and decreased in 2. In the others, preexisting titers were low and unchanged. Serum venom-specific IgE tended to slowly decrease. These clinical and immunologic data suggest that a 4-week maintenance interval may be safely extended.
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239
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Kalfas I, Wilberger J, Goldberg A, Prostko ER. Magnetic resonance imaging in acute spinal cord trauma. Neurosurgery 1988; 23:295-9. [PMID: 3226508 DOI: 10.1227/00006123-198809000-00002] [Citation(s) in RCA: 88] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Magnetic resonance imaging (MRI) has proven to be an invaluable tool for evaluating neoplastic, congenital, and degenerative conditions of the spine and spinal cord. Because of various technical limitations, however, the use of MRI in acutely spinal cord-injured patients has not been fully explored. Sixty-two spinal cord-injured patients underwent MRI within the first 36 hours of injury. A variety of pathological findings were detected on the MRI scans: anatomical cord transection (7 cases), spinal cord deformity secondary to extrinsic compression (28), focal cord enlargement/swelling (21), hyperintense intramedullary lesions (17), and disc herniations (2). MRI may be a useful adjunct in the evaluation of acute spinal cord injury.
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240
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Moore MR, Goldberg A, Yeung-Laiwah AA. Lead effects on the heme biosynthetic pathway. Relationship to toxicity. Ann N Y Acad Sci 1987; 514:191-203. [PMID: 3442384 DOI: 10.1111/j.1749-6632.1987.tb48774.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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241
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Herrick A, McColl KE, McLellan A, Moore MR, Brodie MJ, Goldberg A. Effect of haem arginate therapy on porphyrin metabolism and mixed function oxygenase activity in acute hepatic porphyria. Lancet 1987; 2:1178-9. [PMID: 2890809 DOI: 10.1016/s0140-6736(87)91320-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The effect of haem arginate on porphyrin metabolism and haemoprotein function was studied during seven attacks of acute hepatic porphyria in 5 patients. In each attack it greatly reduced the overproduction of porphyrin precursors and repressed the overactivity of the rate-controlling enzyme of haem synthesis delta-aminolaevulinic acid (ALA) synthase measured in leucocytes. Antipyrine clearance, an index of the oxidative function of cytochromes P-450, the major group of hepatic haemoproteins, was increased during haem therapy. Thus, haem arginate not only suppresses the overproduction of haem precursors but also improves hepatic oxidative metabolism in acute porphyria.
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242
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Bloom SD, Goldberg A. Monte Carlo algorithm for calculating moments of atomic transition arrays. PHYSICAL REVIEW. A, GENERAL PHYSICS 1987; 36:3152-3154. [PMID: 9899231 DOI: 10.1103/physreva.36.3152] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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243
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Manning SC, Beste D, McBride T, Goldberg A. An assessment of preoperative coagulation screening for tonsillectomy and adenoidectomy. Int J Pediatr Otorhinolaryngol 1987; 13:237-44. [PMID: 3679679 DOI: 10.1016/0165-5876(87)90104-2] [Citation(s) in RCA: 65] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Preoperative coagulation studies are commonly employed in order to try to identify the 2-4% of all patients undergoing tonsillectomy/adenoidectomy surgery who experience hemorrhagic complications. In an atmosphere of increasing cost consciousness, evaluation of the efficacy of screening tests is warranted. The records of 994 out of 1050 patients consecutively scheduled for tonsillectomy, adenoidectomy or T&A over a 2.5-year period were retrospectively reviewed in order to determine the usefulness of partial thromboplastin (PTT) and prothrombin time (PT) screening in predicting surgical and postsurgical bleeding. For patients with no history or clinical signs indicating possible bleeding disorder, preoperative PT and PTT failed to predict bleeding as an outcome. Also no patients were identified in this series to have previously undiagnosed coagulopathies on the basis of screening PT/PTT. The purpose of any screening test is to identify disease early enough for therapeutic intervention to be effective. Although preoperative PT/PTT will occasionally identify an unsuspected von Willebrand's or other coagulopathy, the prevalence of bleeding disorders in patients with negative history and examination is low enough that PT/PTT has essentially a zero predictive value for surgical bleeding. Screening PT/PTT should therefore be reserved for patients with known or suspected coagulopathies.
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244
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Lombardi TP, Bertino JS, Goldberg A, Middleton E, Slaughter RL. The effects of a beta-2 selective adrenergic agonist and a beta-nonselective antagonist on theophylline clearance. J Clin Pharmacol 1987; 27:523-9. [PMID: 2888791 DOI: 10.1002/j.1552-4604.1987.tb03060.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Beta-adrenergic agonists and antagonists have been shown to alter theophylline pharmacokinetics. It was the purpose of this study to characterize further the effects that terbutaline and propranolol have on theophylline disposition. In nine healthy male volunteers, mean parameters for theophylline disposition did not change after four days of terbutaline (5 mg q8h). Theophylline clearance, however, did change within the subjects. Clearance increased in five subjects, decreased in three, and remained unchanged in one volunteer. Pretreatment with four days of terbutaline (5 mg q8h) and propranolol (60 mg q8h) significantly decreased mean theophylline clearance (60.1 +/- 12.9 vs 40.6 +/- 9.9 mL/min/1.73m2; P less than .01) increased half-life (8.37 +/- 1.77 vs 12.32 +/- 2.70 hours; P less than .05), and increased postinfusion theophylline concentration (13.5 +/- 2.7 vs 18.95 +/- 2.5 micrograms/mL; P less than .001). In five subjects theophylline clearance increased after terbutaline pretreatment (64.6 +/- 13.0 vs 75.0 +/- 13.9 mL/min/1.73m2). The percentage increase ranged from 3.9 to 28.5%. These subjects were restudied after receiving propranolol alone (60 mg q8h). Comparison between the propranolol and terbutaline study and the propranolol alone study indicated no mean change in clearance in these five subjects (41.8 +/- 12.7 vs 36.1 +/- 5.1 mL/min/1.73m2). Thus it appears that the changes observed in these five subjects after terbutaline pretreatment may have been random in occurrence as has been shown to occur with theophylline disposition and are not related to terbutaline pretreatment. It is concluded that beta-2 adrenergic stimulation does not alter theophylline pharmacokinetics, whereas nonselective beta-adrenergic antagonism profoundly affected theophylline disposition. This is an additional reason not to use propranolol in patients who receive theophylline.
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245
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Slaughter RL, Goldberg A, Choi L, Adams E, Middleton E. Intraindividual variability in theophylline pharmacokinetics in subjects with mild/moderate asthma. J Allergy Clin Immunol 1987; 80:33-8. [PMID: 3598028 DOI: 10.1016/s0091-6749(87)80187-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Intrasubject variability in theophylline pharmacokinetics was assessed in six subjects with mild/moderate asthma. On four occasions, each separated by a minimum of 3 weeks, a 6 mg/kg intravenous aminophylline dose was infused during 30 minutes, and multiple blood samples were obtained thereafter. The pharmacokinetic parameters of clearance (Cl), volume of distribution, and half-life were determined by noncompartmental analysis. There was evidence for within-subject variability in these parameters. In comparison to the first study day, Cl changed by greater than 15% in all but one subject and by greater than 25% in two of six subjects. Changes in half-life exceeding 25% of the value observed on the first study day occurred in three of six subjects. Within-subject coefficient of variation for Cl was 14.9% (range 3.9% to 33.3%) and 14.4% (range 5.8% to 24.3%) for half-life. Volume of distribution, however, was a more stable parameter with a within-subject coefficient of variation of 7.2% (range 2.3% to 11.1%). Thus, within-subject changes in the pharmacokinetics of theophylline do exist over time. These data suggest that close monitoring of patients receiving theophylline is warranted, particularly when theophylline concentrations are maintained at either extreme of the therapeutic range.
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246
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Nevins A, Goldberg A. Wellness is Ageless. THE GERONTOLOGIST 1987. [DOI: 10.1093/geront/27.3.393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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247
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Yeung Laiwah AC, Moore MR, Goldberg A. Pathogenesis of acute porphyria. THE QUARTERLY JOURNAL OF MEDICINE 1987; 63:377-92. [PMID: 3310073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The pathogenesis of the clinical manifestations of acute porphyria has been considered in the light of their pathological changes and their aberrations of the haem biosynthetic pathway. These manifestations may be explained almost entirely upon a neurogenic basis. A number of hypotheses have been considered to explain the clinical, pathological and biochemical features. Of these hypotheses two seem more impressive: (i) the neurological manifestations may be explained by a deficiency of haem in neural tissues; (ii) the porphyrin precursor 5-aminolaevulinic acid (ALA) may have in addition specific pharmacological activity.
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248
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Goldberg A, Asscher AW. Guidelines on halothane. West J Med 1987. [DOI: 10.1136/bmj.294.6579.1100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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249
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Birnie GG, McColl KE, Thompson GG, Moore MR, Goldberg A, Brodie MJ. Antipyrine metabolism in acute hepatic porphyria in relapse and remission. Br J Clin Pharmacol 1987; 23:358-61. [PMID: 3567053 PMCID: PMC1386238 DOI: 10.1111/j.1365-2125.1987.tb03059.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Antipyrine kinetics following a single oral dose were obtained in porphyric patients in attack and in remission and in controls. The clearance of antipyrine was significantly lower during an acute porphyric attack (median: 0.34 ml min-1 kg-1; range: 0.1-0.71, P less than 0.05) than in patients in remission (median: 0.53 ml min-1 kg-1; range: 0.28-0.87) or controls (median: 0.52 ml min-1 kg-1; range: 0.32-0.93). There was a significant negative correlation between weight-adjusted antipyrine clearance and the urinary excretion of the porphyrin precursors, delta-aminolaevulinic acid (r = 0.86, P less than 0.001) and porphobilinogen (r = 0.82, P less than 0.002). These data suggest that the more severe the porphyric attack, the greater the impairment of hepatic monooxygenase activity.
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250
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Fisher BM, MacPhee GJ, Davies DL, McPherson SG, Brown IL, Goldberg A. A case of watery diarrhoea syndrome due to an adrenal phaeochromocytoma secreting vasoactive intestinal polypeptide with coincidental autoimmune thyroid disease. ACTA ENDOCRINOLOGICA 1987; 114:340-4. [PMID: 3564836 DOI: 10.1530/acta.0.1140340] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
A 40 year old woman presented with a 10 year history of watery diarrhoea and an acute quadriparesis. On clinical examination there was severe muscle weakness and a nodule was palpable in the thyroid gland. Biochemical testing revealed a hypokalaemia at 1.6 mmol/l. Plasma levels of VIP were raised at 202 pmol/l. CT scanning demonstrated a mass in the area of the left adrenal gland, and isotope scanning of the thyroid gland showed a 'cold' nodule. The plasma catecholamines and calcitonin were elevated. The patient also presented with psychiatric symptoms, and the relevance of these to her condition has been discussed. At operation a left adrenal tumour was removed. Post-operatively the patient's symptoms disappeared and the plasma hormone levels returned to normal values. Histological examination of the tumour revealed a well differentiated phaeochromocytoma which contained VIP and calcitonin. The thyroid nodule was excised and showed histological features of autoimmune thyroid disease. It is suggested that in all cases of the WDHA syndrome where the tumour is in an extra-pancreatic site patients should be screened for phaeochromocytoma.
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