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Biomedical subjects

B Friedman

Publications and source records attributed to B Friedman.

At least 37 records · Page 2Linked to original sources
PubMed1998

Ischemic colitis and sumatriptan use.

Sumatriptan succinate, a serotonin-1 (5-hydroxytryptamine-1) receptor agonist, is an antimigraine drug that is reported to act by selectively constricting intracranial arteries. Recently, vasopressor responses that are distinct from the cranial circulation have been demonstrated to occur in the systemic, pulmonary, and coronary circulations. Cases have been published of coronary vasospasm, myocardial ischemia, and myocardial infarction occurring after sumatriptan use. We report on the development of 8 serious cases of ischemic colitis in patients with migraine treated with sumatriptan.

Adult↗
PubMed1998

Neuroleptic malignant syndrome in a burn patient.

A 39 year old white male with a 55% total body surface burn who developed neuroleptic malignant syndrome (NMS) during his acute course is reported. The patient had several acute sinusitis and septic episodes during his acute course. On postburn day 31, he developed a temperature of 108.4 degrees F (42.4 degrees C). This responded promptly to Dantrolene and Bromocriptene. His recovery was uneventful. NMS is a drug-related response to various medications, such as Haloperidol, which the patient was receiving. NMS must be considered as part of the differential diagnosis of fever in burn patients receiving medication known to cause the syndrome.

Accidents, Occupational↗
PubMed1997

Trauma-induced striatal CNTF and BDNF mRNA in hemiparkinsonian rats.

Surgical implantation of tissues into the brain causes trauma to the region receiving the graft. This study shows that real or simulated striatal trauma in hemiparkinsonian rats leads to increased expression of two trophic factor mRNAs: ciliary neurotrophic factor (CNTF) and brain-derived neurotrophic factor (BDNF). The baseline expression of BDNF mRNA was also markedly lower in dopamine-depleted striatum than in normal striatum in non-traumatized (control) hemiparkinsonian rats. Striatal CNTF message was relatively symmetrical in the non-traumatized (control) hemiparkinsonian rats. Host production of these and other trophic factors may play important roles in the response to tissue grafting, to enhance graft survival and as a stimulus to regenerative collateral axonal sprouting.

Animals↗
PubMed1997

State variations in Medicare expenditures.

OBJECTIVES: This study examined variations in Medicare expenditures across states. METHODS: 1992 data on average Medicare expenditures per enrollee, users of services per 1000 enrollees, service use per user, and payment per unit of service were compared across states for various services. Weighted least squares regression analysis was employed to examine total Medicare expenditures per enrollee by state. RESULTS: Variation in Medicare expenditures across states is driven more by average number of service users per 1000 enrollees and average service units per user than by average payment per service unit. Medicare expenditures per enrollee by state are primarily a function of Medicare HMO penetration rate (P = .000), urban area (P = .001), hospital bed supply (P = .005), elderly mortality rate (P = .012), Medicare physician assignment rate (P = .026), percentage of primary care practitioners (P = .042), and interactions between urban elderly and percentage of primary care physicians (P = .005) and Black elderly and nursing home bed supply (P = .012). CONCLUSIONS: Before sweeping Medicare cuts are undertaken or excessive reliance on managed care occurs, attention should be focused on the current disproportionate distribution of expenditures across states.

Aged↗
PubMed1997

Supraglottic and subglottic airway injury due to deployment and rupture of an automobile airbag.

A 46-year-old white female with underlying interstitial lung disease and asthma was driving a pickup truck when it was struck broadside. The airbag inflated and then ruptured, forcing inhalation of its contents. This produced facial desquamation, productive cough, wheezing, and headache. Chest radiograph showed bilateral interstitial fibrosis. Pulmonary function tests demonstrated small airway obstruction, hyperinflation, and impaired diffusion. Computerized tomography showed extensive sinusitis. She improved following treatment with inhaled steroids, bronchodilators, and oral antibiotics. Inhalation of the airbag contents produced supraglottic and subglottic airway inflammation, resulting in sinusitis and exacerbation of her underlying asthma.

Air Bags↗
PubMed1996

Swallow function in children with Down syndrome: a retrospective study.

The swallow behavior of 19 children with Down syndrome was reviewed. Findings suggest their oral phase may be impacted by oral hypersensitivity which can interfere with their acceptance of textured foods. A disordered pharyngeal phase was identified in 16 of the children, with aspiration occurring in 10 of the 19 children studied. Aspiration identified was silent for eight of these 10 children with cough data and did not correlate with the severity of their oral phase. Aspiration was, therefore, felt to warrant consideration as a factor in the respiratory illness so often seen in this population.

Child, Preschool↗
PubMed1996

Peptide T in the treatment of painful distal neuropathy associated with AIDS: results of a placebo-controlled trial. The Peptide T Neuropathy Study Group.

OBJECTIVE: To assess the safety and efficacy of Peptide T in the treatment of painful distal symmetrical polyneuropathy (DSP) associated with human immunodeficiency virus (HIV) infection. BACKGROUND: Painful DSP is a frequent complication of HIV infection, although its etiology and optimal treatment are unknown. Peptide T (D-(alpha 1)-Peptide T-amide) has been found in phase I trials and anecdotal reports to relieve neuropathic pain in AIDS patients. DESIGN/METHODS: In this multicentered, double-blind, randomized study, subjects received intranasal Peptide T 6 mg/day or placebo for 12 weeks. The primary outcome measure was change in the modified Gracely pain score. Secondary efficacy variables were results of neurologic examination, neuropsychological and electrophysiologic studies, global evaluation, and CD4 lymphocyte counts. RESULTS: Of 81 evaluable subjects, 40 received Peptide T and 41 received placebo. The change in pain scores was not significantly different (p = 0.32) in the Peptide T group (-0.24) as compared to placebo (-0.39). Group comparisons were not significantly different for change in any clinical examination or neuropsychologic measure, sural nerve amplitude or conduction velocity, or CD4 lymphocyte count. No significant drug-related adverse effects occurred in either group. CONCLUSION: Intranasal Peptide T is safe but ineffective in the treatment of painful DSP associated with AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Interleukin-1 mediates increased plasma levels of eicosanoids and cytokines in patients with sepsis syndrome.

The purpose of this was to study evaluate the effects of interleukin-1 (IL-1) inhibition by human recombinant IL-1 receptor antagonist (IL-1ra) on plasma prostaglandin, leukotriene, and cytokine levels in sepsis syndrome. As part of a multisite, prospective, randomized, double-blind, placebo-controlled clinical trial, 19 septic patients received IL-1ra in a 100 mg bolus followed by 2.0 mg/kg/h i.v. for 72 h (n = 10) or placebo (n = 9). Plasma thromboxane B2 (TXB2), prostaglandin 6-keto-F1 alpha (PGI), leukotriene B4 (LTB4), leukotrienes C4D4E4 (LTC4D4E4), IL-1 beta, IL-6, and tumor necrosis factor alpha (TNF) were measured by ELISA before study drug infusion (baseline) and at 24, 48, 72, and 96 h after the beginning of the study drug infusion. Differences between placebo and IL-1-ra for plasma LTB4 and TNF were not significant. Plasma TXB2, PGI, LTC4D4E4, and IL-6, expressed as % baseline, were significantly lower in patients receiving IL-1ra than in the placebo group (p < .05), while plasma IL-1 was increased significantly. IL-1 may be a necessary mediator of increased circulating PGI, TXB2, LTC4D4E4, and IL-6 levels in patients with sepsis syndrome. Plasma IL-1 is increased with infusion of IL-1ra. The clinical significance of IL-1 in modifying circulating eicosanoid and cytokine concentrations in clinical sepsis is not clear from the data.

Adolescent↗
PubMed1995

Impacts of hospital budget limits in Rochester, New York.

During 1980-87, eight hospitals in the Rochester, New York area participated in an experimental program to limit total revenue. This article analyzes: increase of costs for Rochester hospitals; trends for inputs and compensation; and cash flow margins. Real expense per case grew annually by about 3 percent less in Rochester. However, after 1984, Medicare prospective payment had an effect of similar size outside Rochester. Some capital inputs to hospital care were restrained, as were wages and particularly benefits. The program did not generally raise or stabilize hospital revenue margins, while the ratio of cash flow to debt trended down. Financial stringency of this program relative to alternatives may have contributed to its end.

Budgets↗
PubMed1995

Strategic responses by hospitals to increased financial risk in the 1980s.

OBJECTIVE: This research addresses the following types of responses by hospitals to increased financial risk: (a) increases in prices to privately insured patients (testing separately the effects of risk from the effects of "cost-shifting" that depends on level of Medicare payment in relation to case mix-adjusted cost); (b) changes in service mix offered and selectivity in acceptance of patients to reduce risk; and (c) efforts to reduce variation in resource use for those patients admitted. DATA SOURCES: The database includes a national panel of over 400 hospitals providing information from patient discharge abstracts, hospital financial reports, and county level information over the period 1980-1987. STUDY DESIGN: Econometric methods suitable to panel data are implemented, with tests for pooling, hospital-specific fixed effects, and possible problems of selection bias. PRINCIPAL FINDINGS: The prices paid by private insurers to a particular hospital were affected by the changes in risk imposed by Medicare prospective payment, the generosity of Medicare payment, state rate regulation, and ability of the hospital to bear risk. The risk-weighted measure of case mix did not respond to changes in payment policy, but other variables reflecting the management of care after admission to reduce risk did change in the predicted directions. CONCLUSIONS: Some of the findings in this article are relevant to current Medicare policies that involve risk-sharing, for instance, special allowances for "outlier" patients with unusually high cost, and for sole community hospitals. The first type of allowance appears successful in preserving access to care, while the second type is not well justified by the findings. State rate regulation programs were associated not only with lower hospital prices but also with less risk reduction behavior by hospitals. The design of regulation as a sort of risk-pooling arrangement across payers and hospitals may be attractive to hospitals and help explain their support for regulation is some states.

Cost Allocation↗
PubMed1995

BDNF and NT-4/5 exert neurotrophic influences on injured adult spinal motor neurons.

Adult motor neurons, like their immature antecedents, express the mRNA for the signaling receptor for brain-derived neurotrophic factor (BDNF) and for neurotrophin-4/5 (NT-4/5). However, while both BDNF and NT-4/5 support the survival of axotomized developing spinal motor neurons in vitro or in vivo, it is not known whether these factors continue to influence spinal motor neurons in adulthood. The present study tests if BDNF or NT-4/5 modulate the reactive responses of adult spinal motor neurons to nerve injury. We utilize sciatic nerve transection to axotomize the spinal motor neurons that form the retrodorsal lateral nucleus (RDLN) and show that, after axotomy, RDLN motor neurons lose ChAT immunoreactivity and also reexpress p75Ingfr, the low affinity receptor for all neurotrophin family members. Treatment with BDNF or NT-4/5 alters these effects of sciatic nerve transection. Both BDNF and NT-4/5 attenuate the loss of ChAT expression in axotomized RDLN motor neurons; thus, as compared to vehicle treatments, BDNF and NT-4/5 produce statistically significant increases in the optical density of ChAT immunostaining. Furthermore, BDNF and NT-4/5 also significantly increase the RDLN reexpression of p75Ingfr after sciatic nerve transection. Interestingly, essentially identical increases in RDLN ChAT and p75Ingfr immunostaining are produced by sciatic nerve crush injuries in the absence of exogenous neurotrophin treatment. These data show that treatment with exogenous BDNF and NT-4/5 changes the response of adult spinal motor neurons to sciatic nerve transection. Furthermore, these neurotrophins elicit reactive responses in axotomized motor neurons that mimic those produced by endogenous agents in regenerating crushed peripheral nerve.

Animals↗
PubMed1995

Positioning post-outpatient cardiac catheterization.

UNLABELLED: The optimal positioning post-outpatient cardiac catheterization is a largely unexplored area of research. Traditionally, patients have been placed supine, with the head of the bed (HOB) flat. This study sought to explore the influence of three different post-procedure positions on the incidence of complications and patient perceptions of satisfaction. Sixty-nine patients were randomized into three groups immediately after hemostasis of the arterial puncture site was achieved. Group 1 patients were placed supine with the HOB flat. Group 2 patients were placed on their sides, with the affected extremity straight. Group 3 patients were placed on their backs, with the HOB at 15-30 degrees. Endpoints included the presence of any complication (bleeding, hematoma formation or expansion, back pain and urinary retention) and patient comfort and satisfaction with the randomized position. Patients were asked prior to discharge to select the position they would have preferred post-procedure. Selection of an alternative position was felt to indicate dissatisfaction with the randomized position. Ten patients in Group 1, and nine patients in Group 2 and Group 3 experienced a complication (X2 = 3.682, df = 1, p = 0.05). Eighty-five percent of Group 1 patients selected an alternative position vs. 24% of those patients in Group 2 and Group 3 (X2 = 27.6, df = 1, p < .001). CONCLUSION: varying patient position post-outpatient cardiac catheterization is at least as safe as the traditional supine position and is more comfortable for patients.

Adult↗