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Biomedical subjects

Gary E Friedlaender

Publications and source records attributed to Gary E Friedlaender.

13 recordsLinked to original sources
PubMed2006

The 80-hour duty week: rationale, early attitudes, and future questions.

There is considerable concern and much evidence resident fatigue results in medical errors, some of which have serious consequences. Similarly, fatigue causes poor health in house-staff and places these individuals at greater risk for personal injuries, including motor vehicle accidents. These circumstances led the Accreditation Council on Graduate Medical Education to develop and, on July 1, 2003, to implement guidelines for all residency training programs limiting the time of in-house duty to 80 hours per week. Surveys of orthopaedic residents by the American Academy of Orthopaedic Surgeons, before and right after implementation of these new duty rules, confirm housestaff were working longer than 80 hours before July 2003 and are largely in compliance since that date. Residents generally approve of these changes and are personally happier, but also express concern for a loss of continuity of care and reduced exposure to operative cases. It remains to be demonstrated whether these new rules will improve patient care, enhance housestaff well-being, or influence education.

Accreditation↗
PubMed2006

Metastatic disease of the spine.

Metastatic spine disease accounts for 10% to 30% of new cancer diagnoses annually. The most frequent presentation is axial pain. A thorough spinal examination includes assessment of local tenderness, deformity, limitation of motion, and signs of nerve root or cord compression. Plain radiographs are obtained routinely; for a suspected or known malignancy, radionuclide studies are essential. Magnetic resonance imaging is more specific than bone scans. Computed tomography-guided biopsy is considered to be safe and accurate for evaluating spinal lesions. Treatment is multidisciplinary, and virtually all treatment is palliative. Management is guided by three key issues: neurologic compromise, spinal instability, and individual patient factors. Site-directed radiation, with or without chemotherapy, is the mainstay of treating painful lesions that are not impinging on neural elements. New data documenting the benefit of surgical decompression using improved techniques such as anterior approaches have amplified the role of the spine surgeon in the care of these patients.

Decompression, Surgical↗
PubMed2004

Comparison of posterolateral lumbar fusion rates of Grafton Putty and OP-1 Putty in an athymic rat model.

STUDY DESIGN: Posterolateral lumbar spine fusions in athymic rats. OBJECTIVES: To compare spine fusion rates of two different osteoinductive products. SUMMARY OF BACKGROUND DATA: Many osteoinductive bone graft alternatives are available. Grafton (a demineralized bone matrix [DBM]) and Osteogenic Protein-1 (OP-1, an individual recombinant bone morphogenetic protein) are two such alternatives. The relative efficacy of products from these two classes has not been previously studied. The athymic rat spine fusion model has been validated and demonstrated useful to minimize inflammatory responses to xenogeneic or differentially expressed proteins such as those presented by DBMs of human etiology. METHODS: Single-level intertransverse process fusions were performed in 60 athymic nude rats with 2 cc/kg of Grafton or OP-1 Putty. Half of each study group was killed at 3 weeks and half at 6 weeks. Fusion masses were assessed by radiography, manual palpation, and histology. RESULTS: At 3 weeks, manual palpation revealed a 13% fusion rate with Grafton and a 100% fusion rate with OP-1 (P = 0.0001). At 6 weeks, manual palpation revealed a 39% fusion rate of with Grafton and a 100% fusion rate with OP-1 (P = 0.0007). Similar fusion rates were found by histology at 3 and 6 weeks. Of note, one or two adjacent levels were fused in all of the OP-1 animals and none of the Grafton animals. CONCLUSIONS: Significant differences between the ability of Grafton and OP-1 to induce bone formation in an athymic rat posterolateral lumbar spine fusion model were found.

Activin Receptors, Type I↗
PubMed2004

The 2002 Marshall Urist Young Investigator Award Paper. Lumbar arthrodesis gene expression: a comparison of autograft with osteogenic protein-1.

Data from animals have revealed that osteogenic protein-1 induces solid intertransverse process fusion more reliably than autograft, and has motivated the question: What is the difference in the fusion bed environment engendered by the addition of osteogenic protein-1? To address this question, an established New Zealand White rabbit model of spinal arthrodesis was used to evaluate the effect of iliac crest autograft, and alternatively osteogenic protein-1, on cytokine gene expression in the developing spinal fusion mass. The autograft group and the osteogenic protein-1 group had a similar pattern of gene expression for most of the cytokines investigated, highlighting the finding that the application of one bone morphogenetic protein to the fusion bed results in nearly the same gene expression as that resulting from application of autologous bone. Some differences in cytokine expression were observed at the fusion bed with the addition of osteogenic protein-1. The increased level of expression of particular osteogenic, chondrogenic, and angiogenic growth factors at the later stages of fusion may be responsible for the improved rate of solid fusion with osteogenic protein-1 as compared with autograft alone. Sequences for bone morphogenetic protein-5 and bone morphogenetic protein-7 were determined, and their respective expression in the developing spinal fusion mass was observed for the first time.

Animals↗
PubMed2004

Osteogenic protein-1 in treatment of tibial nonunions: current status.

Between 5% to 10% of tibial fractures progress to nonunion, causing substantial disability. Bone autografts, along with internal fixation, are the usual treatment for these failures, but the morbidity associated with autogenous tissues remains problematic. Bone morphogenetic proteins are currently available for clinical use and preclinical models, as well as an increasing number of patients treated with these molecules demonstrate their safety and efficacy. Osteogenic Protein-1, OP-1, has been evaluated in a randomized, prospective, multi-institution study of tibial nonunions. Sixty-one patients with 63 nonunions received OP-1 and intramedullary rod fixation, and were compared with 61 patients with 61 nonunions treated with fresh autogenous bone graft and the same fixation. Clinical outcomes (success in 81% of OP-1 and 85% of autograft-treated patients) and radiographic evaluation (healing in 75% of OP-1 and 84% of autograft-treated patients) were statistically indistinguishable at 9 months following treatment. No OP-1 or graft-related adverse events occurred. More than 20% of the autograft group had significant donor-site pain 6 months following surgery. OP-1 is a safe and effective alternative to autogenous bone in treatment of tibial nonunions.

Adolescent↗
PubMed2003

Curricular reform in musculoskeletal medicine: needs, opportunities, and solutions.

Musculoskeletal medicine is not taught adequately in American medical schools and the predictable consequences are seen. Students cannot show cognitive mastery of the subject and lack confidence in this topic. To address this, the Academic Orthopaedic Society held a symposium on medical school education at its annual meeting in 2001. There, the panelists presented an analysis of the problem and proposed solutions. Specifically, it was noted that because of the autonomy of the various schools and their varied approaches to teaching, it would be unlikely that one monolithic and mandated plan could be effective on a national basis. Rather, successful reform would comprise a coalition-based effort to define learning objectives, to provide teaching materials, and to create forums for sharing resources. Recruitment of national organizations was thought to be essential. Finally, it was felt that although inadequate education is neither new nor necessarily unique among disciplines, the coming year or two, the beginning of the Bone and Joint decade, was seen to be a particularly auspicious time for attempting curricular reform.

Curriculum↗
PubMed2002

Editorial comment.

Explore the source record for details and available documents.

Education, Medical, Graduate↗
PubMed2002

Sequential dependence of freeze-drying and irradiation on biomechanical properties of rat bone.

Femurs of Sprague-Dawley rats were subjected to in vitro 3-Mrad irradiation and/or freeze-drying to investigate whether these processes have an order-dependent effect on the biomechanical properties of bone. Four experimental groups were designated-irradiated (RAD); freeze-dried (FD); irradiated, then freeze-dried (RAD/FD); and freeze-dried, then irradiated (FD/RAD). After the various treatments, the bones were inspected for microfractures and then torsion-tested. Microfractures were seen in more than 90% of the specimens that had undergone freeze-drying alone or with irradiation. Regarding the normalized relative ratios of torque, there was a statistically significant difference (P < .05) between the RAD group (1.0) and the 3 other groups (FD, .32; RAD/FD, .40; FD/RAD, .14). Differences among the FD, RAD/FD, and FD/RAD groups were not significant. However, a trend was bones were weaker than FD and noted: FD/RAD RAD/FD bones.

Animals↗
PubMedDate not supplied

Posterolateral lumbar fusions in athymic rats: characterization of a model.

BACKGROUND CONTEXT: The athymic rat has been used to study the role of osteoinductive products in spinal fusions. This small animal model has been advocated to minimize potential inflammatory responses to allogeneic or xenogenic proteins. Despite past experience, this model has not yet been well characterized. PURPOSE: To further define and validate a posterolateral lumbar fusion model in the athymic rat. STUDY DESIGN/SETTING: Comparison of fusions after animal survival surgery. PATIENT SAMPLE: Forty athymic and 20 normothymic rats. OUTCOME MEASURES: Manual palpation, radiography and histology at 3 and 6 weeks. METHODS: Single-level intertransverse fusions were performed at the L4-L5 level of 40 athymic rats. Twenty rats were implanted with autograft (athymic/autograft), and 20 had no graft placed (athymic/no graft). An additional 20 autograft fusions were performed on normothymic rats (normothymic/autograft). Half were sacrificed at 3 weeks; half were sacrificed at 6 weeks. RESULTS: At 3 weeks, 0% of the athymic/no graft rats fused, 20% of the athymic/autograft rats fused and 20% of the normothymic/autograft rats fused by manual palpation. At 6 weeks, 0% of the athymic/no graft rats fused, 30% of the athymic/autograft rats fused and 40% of the normothymic/autograft rats fused by manual palpation. Radiographs were of limited utility in determining fusion, and histology results were roughly concordant with those of manual palpation. CONCLUSIONS: This work further characterizes the athymic rat posterolateral lumbar fusion model. The absence of a thymus does not appear to affect autograft fusion rates, and no spontaneous fusions were seen when no graft was placed.

Animals↗
PubMedDate not supplied

Malignant bone tumors: limb sparing versus amputation.

Amputation, once the mainstay of treatment of malignant bone tumors, now is used selectively and infrequently. Most patients are candidates for limb-sparing procedures because of effective chemotherapeutic agents and regimens, improved imaging modalities, and advances in reconstructive surgery. Patient age as well as tumor location and extent of disease help define the most appropriate surgical alternatives. Options for skeletal reconstruction include modular endoprostheses, osteoarticular or bulk allografts, allograft-prosthetic composites, vascularized bone grafts, arthrodesis, expandable prostheses, rotationplasty, and limb-lengthening techniques. Two key factors must be considered: survival rates should be no worse than those associated with amputation, and the reconstructed limb must provide satisfactory function. Functional outcome studies comparing limb-sparing procedures and amputation have inherent limitations, including the inability to randomize treatment and the subjective nature of important outcome measures.

Amputation, Surgical↗