Browse Health
Internist
40 years of experience

Education ?

Medical School Score Rankings
University of Rochester (1970)
  • Currently 4 of 4 apples
Top 25%

Awards & Distinctions ?

Associations
American Board of Internal Medicine

Affiliations ?

Dr. Goldstein is affiliated with 1 hospitals.

Hospital Affilations

Score

Rankings

  • Beth Israel Deaconess Medical Center
    330 Brookline Ave, Boston, MA 02215
    • Currently 4 of 4 crosses
    Top 25%
  • Publications & Research

    Dr. Goldstein has contributed to 28 publications.
    Title Surgical and Calcium Outcomes in 427 Patients Treated Prospectively in an Image-guided and Intraoperative Pth (iopth) Supplemented Protocol for Primary Hyperparathyroidism: Outcomes and Opportunities.
    Date March 2009
    Journal The Laryngoscope
    Excerpt

    Unilateral exploration based upon preoperative imaging has become increasingly applied in the management of patients with primary hyperparathyroidism. Unilateral surgical exploration purportedly has high rates of disease control, limited morbidity, and shortened operative time. Unfortunately, significant cohorts of patients with primary hyperparathyroidism are unable to have abnormal glands localized on preoperative imaging evaluation.

    Title Fulminant Liver Failure Due to Usnic Acid for Weight Loss.
    Date June 2004
    Journal The American Journal of Gastroenterology
    Excerpt

    The use of complementary and alternative medicine (CAM) in developed countries has increased significantly over the years. Among the most popular are the weight loss supplements or "fat burners." Liver failure due to these popular remedies has been widely recognized. Usnic acid has been an ingredient of dietary supplements that cause liver failure. Its hepatotoxicity has not been recognized because it is usually mixed with other ingredients that are presumably hepatotoxic. We describe a case of a 28-yr-old woman who presented with fulminant liver failure requiring orthotopic liver transplantation, after taking pure usnic acid for weight loss. This is the first report on fulminant liver failure associated with the ingestion of pure usnic acid. A discussion about hepatotoxicity of the different compounds of dietary supplements is presented. This is a reminder for the clinicians about the potential side effects of CAM.

    Title "back to the Future".
    Date October 2000
    Journal Medical Group Management Journal / Mgma
    Title Psychiatric Poetic License? Post-mortem Disclosure of Confidential Information in the Anne Sexton Case.
    Date April 1994
    Journal Psychiatric Annals
    Title More Forensic Romances: De Clérambault's Syndrome in Men.
    Date January 1988
    Journal The Bulletin of the American Academy of Psychiatry and the Law
    Excerpt

    De Clérambault's syndrome (erotomania) has invariably been regarded as a female disorder (with male victims); however, a number of recent reports describe male patients with the disorder, especially in violence-prone male offender populations. Seven cases are presented of violence-prone men suffering from the disorder, including Hinckley and Poddar. The syndrome is discussed from a nosological point of view and in terms of its impact on competency to stand trial. Psychiatrists should be aware that the syndrome is not a rarity among men, as previously thought, and that proper diagnosis and management are essential in view of the clinical course of the disorder and the potential for violence when the patient's "love" is persistently unrequited by the delusional love object.

    Title Litigious Paranoids and the Legal System: the Role of the Forensic Psychiatrist.
    Date September 1987
    Journal Journal of Forensic Sciences
    Excerpt

    Forensic psychiatrists should be aware of the many ways that paranoid individuals may present within the legal system. Litigious paranoids often utilize the legal system as a vehicle to act out their fantasies and delusional preoccupations. Imaginary grievances, accusations based on delusional ideation, and irrational vindictiveness toward imagined persecutors may find full expression in any number of legal contexts. They can defeat the rational and legitimate objectives of the legal system, enmesh innocent and unsuspecting victims in nightmarish legal entanglements, and subvert the process of justice. The forensic psychiatrist can assist the court by alerting it to the presence of paranoid illness in parties or witnesses and by clarifying what the effects of such psychopathology are and what the most favorable response should be. Three legal contexts wherein paranoid individuals may present within the legal system are discussed: the "hypercompetent" defendant, the paranoid party in a divorce proceeding, and the paranoid complaining witness. Case illustrations are presented for each legal context. Two issues are discussed: the dividing line between paranoid ideation (and its impact on the legal process) and so-called "normal" thinking (and its objective to use the legal process to obtain certain ends); and the degree to which psychiatric opinions in this area should influence the way an individual's case is handled by the legal system. The author concludes that, despite the costs involved, it is preferable that even paranoids have their "day in court."

    Title The Psychiatrist's Role in Retrospective Determination of Suicide: an Uncertain Science.
    Date June 1987
    Journal Journal of Forensic Sciences
    Excerpt

    Psychiatrists have made significant contributions to our understanding of the phenomenon of suicide and are generally regarded as experts in all matters relating to suicide. When a legal determination must be made as to whether an individual has died as a result of suicide or by accidental (or any other) means, psychiatrists are often called upon to proffer their expert opinion to assist the courts to resolve the matter. Two case illustrations are presented and analyzed in which psychiatrists were called upon to make such retrospective determinations of suicide. The question is raised as to whether psychiatrists may sometimes exceed the limits of their scientific expertise in making such determinations.

    Title Psychiatrists and Personal Injury Litigation.
    Date November 1986
    Journal The American Journal of Psychiatry
    Title Functional Outcomes Following Medical Intensive Care.
    Date October 1986
    Journal Critical Care Medicine
    Excerpt

    This study describes the long-term functional outcomes of a medical and coronary care ICU population. Baseline and 1-yr follow-up data were collected prospectively from all 2213 patients admitted during a 2-yr period. Patients were stratified into three groups based on their preadmission functional status: active (n = 917), sedentary (n = 1017), or severely limited (n = 279). Those with severe functional limitation before admission were twice as likely to undergo major interventions (p less than .005). This group also had a significantly (p less than .001) higher mortality and incurred significantly (p less than .01) higher hospital charges than the other two groups, even though hospital lengths of stay were similar. Finally, cumulative mortality was significantly (p less than .001) greater for the severely limited patients: 33% expired in the ICU, 42% died while still in the hospital, and 63% died after discharge. Most survivors regained their preadmission functional status, with 60% of the previously employed returning to work. However, even for hospital survivors, mortality was high and was related to prior functional status: active 7%, sedentary 20%, severely impaired 37%.

    Title Erotomania in Men.
    Date June 1986
    Journal The American Journal of Psychiatry
    Title Forensic Psychiatry and Literature Part I: Simenon's Syndrome or De Clérambault's Syndrome? (a Psycho-literary Postscript to Erotomania).
    Date June 1986
    Journal Psychiatric Journal of the University of Ottawa : Revue De Psychiatrie De L'université D'ottawa
    Title The Doctor-patient Relationship in Psychiatry: a Threshold Issue.
    Date March 1986
    Journal Journal of Forensic Sciences
    Title Clinical Utility of Serum Digoxin Level Tests in Hospitalized Elderly Patients.
    Date February 1986
    Journal Archives of Physical Medicine and Rehabilitation
    Excerpt

    To assess the clinical utility of serum digoxin tests in the elderly and to ascertain the use by physicians of test results, digoxin levels were obtained from 77 consecutive, elderly patients (means age 72 years) taking digoxin on admission to a rehabilitation hospital. Blood samples were drawn the morning following admission (prior to the administration of digoxin) and were repeated in two weeks. Signs or symptoms of digoxin toxicity were seen in all 13 patients with levels above the therapeutic range. Of 38 patients with therapeutic levels, 16 had signs or symptoms compatible with underdigitalization or digoxin toxicity. Physicians were significantly more likely to respond to both the initial and follow-up serum digoxin test result when the first test result was above the therapeutic range.

    Title Hospital Readmissions Among Survivors Six Months After Myocardial Revascularization.
    Date July 1985
    Journal Jama : the Journal of the American Medical Association
    Excerpt

    One neglected but important measure of early morbidity after coronary artery bypass graft (CABG) operations is rehospitalization. As part of a prospective study of recovery after elective CABG procedures conducted at four academic medical centers, data from all readmissions occurring within the first six postoperative months were collected for 326 patients. A total of 24% of patients had readmissions. The most common categories of readmission discharge diagnoses were cardiac (57%), noncardiac (26%), and surgical sequelae (17%). Factors from the initial hospitalization identified as risk factors for rehospitalization included: length of stay in intensive care unit after surgery, severe noncardiac complications, duration of preoperative cardiac symptoms, intra-aortic balloon insertion, and preoperative resting angina. These findings help to identify a subset of at risk patients for whom more careful surveillance might be beneficial.

    Title Nursing Home Patients Admitted to a Medical Intensive Care Unit.
    Date December 1984
    Journal Medical Care
    Excerpt

    To investigate admissions from nursing homes to a medical intensive care unit (ICU), the authors detailed the major interventions, costs, and outcomes for such patients (n = 67) over a 3-year period and then compared them with those for ICU patients receiving home care or visiting nurse services (240 patients) before admission and all others older than 65 years of age (949 patients). These three groups comprised 37% of total ICU admissions. In contrast to younger patients admitted primarily with acute ischemic heart disease, nursing home patients were more likely to be admitted with cardiopulmonary arrest, infection, and gastrointestinal bleeding. Major interventions of intubation and mechanical ventilation were most frequent for nursing home patients, but total hospital charges differed little among the groups. In-hospital mortality for the nursing home group (28%) was significantly higher than for the home care group (7%) and others older than 65 years of age (7%). Cumulative mortality for the nursing home group reached 66% by 8 months, versus 32% and 26% in the other groups, respectively.

    Title Sigmund Freud: Forensic Psychiatrist.
    Date January 1984
    Journal The Bulletin of the American Academy of Psychiatry and the Law
    Title Predictors of Employment Status After Cardiac Surgery.
    Date March 1983
    Journal Jama : the Journal of the American Medical Association
    Excerpt

    Preoperative predictors of postoperative employment status were studied in 228 patients (aged 25 to 64 years) who underwent cardiac surgery. Of the 150 patients working in the year before surgery, 73% returned within six months. Of those not so employed, 18% started working. Patients who expected preoperatively to return to work did so at an 82% rate compared with 39% of the others. This was a strong predictor in the multiple regression analysis. Educational level and family income were stronger predictors than occupation or level of physical exertion required. Rates of return were higher in patients with less severe angina and less fatigue preoperatively, but did not differ significantly by sex, surgical procedure, or duration of illness. Seven variables predicted work status correctly for 86% of persons. These results suggest that determinants of return to work are largely present before surgery and that patients' attitudes and expectations play an important role.

    Title Medical Intensive Care for the Elderly. A Study of Current Use, Costs, and Outcomes.
    Date December 1981
    Journal Jama : the Journal of the American Medical Association
    Excerpt

    All admissions (2,693) to a medical intensive and coronary care unit (ICU/CCU) during a two-year period were reviewed to compare indications for admission, major interventions, and outcomes for elderly patients with those for younger patients. Once admitted to the ICU/CCU, older patients were more likely to receive major life-support interventions such as mechanical ventilation but less likely to survive. Major interventions were used in 32% of patients aged 75 years or older, in 26% of those 65 to 74 years, and in 22% of those 55 to 64 years. Nonetheless, elderly patients had no longer mean lengths of stay and no greater mean hospital charges. Hospital mortality for the oldest patients was 16%, compared with 14% and 8% for the younger age groups. Cumulative mortality one year after discharge for those older than 75 years was 44%. Elderly hospital survivors returned to their preadmission living situation but did not regain their preadmission activity level.

    Title Credibility and Incredibility: the Psychiatric Examination of the Complaining Witness.
    Date November 1980
    Journal The American Journal of Psychiatry
    Excerpt

    Psychiatrists are called on to evaluate the credibility (and incredibility) of complaining witnesses in criminal proceedings despite a longstanding controversy about their ability to accurately make such determinations. The author discusses the history of such psychiatric activity from Freud through the Alger Hiss prejury trial, its current status in terms of benefits to the criminal justice system, the legal and social questions it raises (e.g., the competing issue of the complainant's right to privacy), andthe court's restrictions on the psychiatrists. He presents two illustrative case histories.

    Title Medical Intensive Care: Indications, Interventions, and Outcomes.
    Date May 1980
    Journal The New England Journal of Medicine
    Excerpt

    To evaluate current practices regarding intensive-care units (ICU's), we collected data on 2693 consecutive admissions to a medical ICU during a two-year period and studied indications for admission, specific interventions, costs, and outcomes. The need for noninvasive monitoring rather than immediate major interventions prompted 77 per cent of the admissions. Only 10 per cent of monitored patients had subsequent indications for major interventions. The 23 per cent who required immediate interventions accounted for disproportionate shares of total charges (37 per cent) and deaths during hospitalization (58 per cent). Demographic and diagnostic data indicate that the aged and chronically ill have become the principal consumers of intensive care. Overall mortality during hospitalization was 10 per cent; cumulative mortality during follow-up study (mean duration, 15 months) was 25 per cent. We conclude that identification of sensitive predictors of complications and specific predictors of mortality can lead to more efficient and effective ICU practices.

    Title De Clérambault in Court: a Forensic Romance.
    Date January 1979
    Journal The Bulletin of the American Academy of Psychiatry and the Law
    Title When Doctors Disagree: Differing Views on Competency.
    Date December 1977
    Journal The Bulletin of the American Academy of Psychiatry and the Law
    Title Data for Peer Review: Acquisition and Use. Results in the Experimental Medical Care Review Organization Program.
    Date May 1975
    Journal Annals of Internal Medicine
    Excerpt

    Nine Experimental Medical Care Review Organizations (EMCROs) review the process and outcome of medical care, using insurance billing claims or medical record abstracts as the data source. The cost of EMCRO insurance billing claims processing in 1972, including peer review, ranged from $0.47 to $2.50 per claim. Three EMCROs reviewed the necessity for elective hospital admission prospectively for $2.50, $8.50, and $10.02 per case. The EMCROs developed innovative methods for abstracting hospital, nursing home, and ambulatory medical records at a cost of $0.40 to $4.00 per abstract. These EMCRO cost estimates were not derived from uniform accounting methods. Problems of accuracy and comparability of data for peer review are discussed. The EMCRO experience may aid local implementation of Professional Standards Review Organizations (PSROs).

    Title Peripheral Neuropathy Presenting with Respiratory Insufficiency As the Primary Complaint. Problem of Recognizing Alveolar Hypoventilation Due to Neuromuscular Disorders.
    Date May 1974
    Journal The American Journal of Medicine
    Title "the Fitness Factory". I. The Psychiatrist's Role in Determining Competency.
    Date November 1973
    Journal The American Journal of Psychiatry
    Title Those Who Kill Without Thinking.
    Date February 1973
    Journal The American Journal of Psychiatry
    Title Research and Development in Quality Assurance. The Experimental Medical Care Review Organization Program.
    Date January 1973
    Journal The New England Journal of Medicine
    Title Passive Mode Locking of Lasers with a Tunable Dye Cell.
    Date
    Journal Optics Letters
    Excerpt

    A laminar-flow dye cell with continuously variable thickness (tunable without removal of the dye solution) provides an excellent way of optimizing passively mode-locked lasers. Varying the cell thickness adjusts low-light-level transmittance to match the total cavity and excitation energy conditions and also varies pulse duration. Acceptable cell thicknesses and dye concentrations can be calculated theoretically using well-known parameters. The cell can be conveniently retuned to compensate for dye degradation or to provide conditions for Q switching. Experimental evidence is presented for a Nd:YAG laser.

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