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Biomedical subjects

J A Friedman

Publications and source records attributed to J A Friedman.

35 records · Page 2Linked to original sources
PubMed2000

Migration of an intraspinal schwannoma documented by intraoperative ultrasound: case report.

BACKGROUND: Tumors of the cauda equina may shift with positioning on the operating table. Accurate localization at surgery is important to facilitate appropriate laminectomy and durotomy. CASE DESCRIPTION: We report a case of a 28-year-old man with a schwannoma of the cauda equina at L4 on preoperative MRI. Intraoperative ultrasound revealed that the tumor had migrated cephalad, and was now located at L3. CONCLUSION: Intraoperative ultrasound is a valuable technique in localization of tumors of the cauda equina.

Adult↗
PubMed2000

Development of a cerebral arteriovenous malformation documented in an adult by serial angiography. Case report.

This 61-year-old man with a right-sided tentorial dural arteriovenous fistula (DAVF) was initially treated with staged stereotactic radiosurgery and transarterial embolization. Results of follow-up cerebral angiography performed 4 years later demonstrated complete obliteration of the dAVF and development of a previously undetected cerebellar arteriovenous malformation (AVM). The newly diagnosed AVM was treated with repeated stereotactic radiosurgery. This represents the first reported case of the development of a cerebral AVM documented in an adult by serial angiography.

Cerebellum↗
PubMed2000

Meningoencephalitis due to Blastomyces dermatitidis: case report and literature review.

Infection of the central nervous system by Blastomyces dermatitidis is a rare cause of meningoencephalitis. The existence of exclusive clinical infection of the meninges in the absence of pulmonary or other foci of infection has been debated. We describe a 20-year-old man presenting with meningoencephalitis caused by B dermatitidis. Blastomycotic infection was confirmed by isolation of the organism from brain tissue obtained at biopsy. Magnetic resonance imaging demonstrated progressive enhancement of basal meninges with involvement of bilateral basal ganglia and thalami. Treatment with amphotericin B arrested further neurologic decline. However, clinical and radiographic follow-up suggested damage to diencephalic structures. The diagnosis of blastomycotic meningoencephalitis is difficult to establish because no sensitive serologic test exists, and attempts to isolate the organism in cerebrospinal fluid obtained by lumbar puncture generally fail. A biopsy specimen of brain tissue is frequently necessary for the diagnosis. Survival is possible with timely initiation of therapy.

Adult↗
PubMed1997

Considerations in pharmaceutical conversion: focus on antihistamines.

The practice of pharmaceutical conversion, which encompasses three types of drug interchange (generic, brand, and therapeutic substitution), is increasing in managed care settings. Pharmaceutical conversion has numerous implications for managed care organizations, their healthcare providers, and their customers. Although drug cost may be a driving consideration in pharmaceutical conversion, a number of other considerations are of equal or greater importance in the decision-making process may affect the overall cost of patient care. Among these considerations are clinical, psychosocial, and safety issues; patient adherence; patient satisfaction; and legal implications of pharmaceutical conversion. Patient-centered care must always remain central to decisions about pharmaceutical conversion. This article discusses the issues related to, and implications of, pharmaceutical conversion utilizing the antihistamines class of drugs as the case situation.

Automobile Driving↗
PubMed1995

Ferenczi's Clinical Diary: on loving and hating.

The author considers that Ferenczi's work has had a significant influence both on theorising and on the clinical practice of psychoanalysis. His 'Diary', written with such personal candour and presented with such consistency of reflective orientation, reveals many of the assumptions that found Ferenczi's work and thought. One enormously significant aspect of Ferenczi's work concerns his rendering of hatred and hate-reactions as 'insane' and 'unreal'. This understanding is based on a view of the infant/child as originally non-instinctually-driven, as gentle, tender and, in a definite sense, wise/omniscient. Love between individuals would be the only emotional tie proper to this natural arrangement. Given such a rendering, the interpretation of the significance of the patient's own hate/hatred in the treatment setting is inevitably and necessarily foreclosed. In place of this, the analyst's/Ferenczi's own hatred is revealed in 'mutual analysis' in the hope that through this 'confession' the analyst's emotional failings and limitations may be 'forgiven'. It is argued that this foreclosure of the interpretation and handling of hate in the treatment only increases its persecutory aspect. It is further argued that 'love-offerings' within or even outside of treatment, in any form, are never an adequate response to persecutory hate, and this for precise reasons.

Adult↗
PubMed1990

Six children with lead poisoning.

Although most commonly seen in children from lower socioeconomic backgrounds, all children are at risk for lead poisoning. Management is a potential problem for all primary care providers. Because few individuals in the primary care practice of pediatrics have many patients with lead poisoning, it may be difficult to understand the nuances of management. We describe six patients, each of whom reflects different aspects of lead poisoning in children, and discuss the lessons we have learned in the course of their treatment. We have found that graphic representation of the blood lead and erythrocyte protoporphyrin values is helpful in the longitudinal follow-up of these youngsters.

Child, Preschool↗
PubMed1989

Effects of flossing on plaque and gingivitis in third grade schoolchildren.

The purpose of this investigation was to determine whether flossing, as an adjunct to toothbrushing, performed in a school-based program can contribute significantly to a reduction in gingivitis. Four volunteer third grade classrooms (n = 112) were randomly assigned to finger-floss, looped-floss, flossholder, and brushing-only control group. Measures taken at baseline and in four weeks included gingival (GI), plaque (PI), and flossing dexterity indices (FDI). Results using ANOVA showed no differences in PI among groups. However, both brushing-only and finger-floss groups showed GI scores significantly lower than the looped-floss group. A repeated measures ANOVA revealed that the finger-floss group improved gingivitis scores most over time, while the flossholder group improved scores the least. The ANCOVA results with FDI showed that at the final measurement, looped-floss manual dexterity was rated significantly better than finger-floss and that both groups were rated better than flossholder. Final indications are that toothbrushing alone can produce clinical results similar to use of a combination of toothbrushing and flossing.

Child↗
PubMed1988

Nuclear glucocorticoid receptor binding in L6 skeletal muscle cells in culture.

Mechanisms underlying glucocorticoid hormone actions on skeletal muscle remain incompletely understood. This problem may be amenable to solution with a simple cell culture system in which the hormonal environment can be controlled. In this report, we demonstrate that the L6 muscle cell line may provide such a system. These cells, which possess many morphological and functional characteristics of skeletal muscle, originate as mononuclear myoblasts, which fuse to form multinucleated myotubes. L6 myoblasts and myotubes contain an intracellular glucocorticoid receptor that has binding parameters and ligand specificity similar to those of glucocorticoid receptors of classical glucocorticoid target tissues. A major advantage of the use of cultured cells is ease of isolation of myonuclei that display specific glucocorticoid receptor binding. L6 muscle cells should provide a valuable model system for further studies of the mechanisms of glucocorticoid hormone actions on muscle.

Animals↗
PubMed1987

Home health care.

Explore the source record for details and available documents.

Community Health Nursing↗
PubMed1983

The special patient on the medical/surgical ward.

The "special" or favoured patient may play a very important role in the ward milieu. Such patients are discussed in terms of their adaptive function for medical and nursing staff in dealing with feelings of pessimism, anger and guilt. The attitudes of protectiveness and infantilization and staff dissention make the task of the psychiatrist hazardous when consultation is requested. Two clinical examples are discussed: one in which the issue of "specialness" was overlooked, and one in which it was dealt with. The consulting psychiatrist's own reactions of anger and therapeutic nihilism may alert him to such a patient. Intervention must take into account the trust implied in being asked to see a "special" patient and the tremendous emotional investment on the part of the staff. The consultant should use his own reactions to the patient to help staff identify the feelings aroused in them by such patients. Meeting with the staff collectively to share concerns and resolve conflict is productive and should be encouraged.

Adolescent↗
PubMedDate not supplied

A community-based cohort of 201 consecutive patients with primary Sjögren's syndrome in Israel: Ashkenazi patients compared with those of Sephardic descent.

OBJECTIVE: To determine the spectrum and prevalence of the varied manifestations, associated conditions and laboratory abnormalities of patients with primary Sjögren's syndrome in Israel and compare them between individuals of Sephardic and Ashkenazi descent and with data from the literature. METHODS: A retrospective study of a cohort of 201 consecutive patients diagnosed and followed at a single academic medical center. All cases were diagnosed using stringent criteria according to the American European Concensus Group including a labial minor salivary gland biopsy in all cases. RESULTS: Patients' mean age was 57 years and 84% were women. Overall, more than 98% of patients had sicca symptoms of dry eyes and mouth. About 35% of the cohort had hematological manifestations--primarily immune cytopenias, protein immunoelectrophoresis abnormalities and lymphoma. About 20% had associated neurological conditions (not only peripheral but often central nervous system) and 15% had pulmonary involvement. In addition, thyroid disease, liver disease, vascular or cutaneous manifestations, synovitis, ocular and renal disease could be found. In fact, the presenting manifestation was extraglandular or an abnormal test result in 39% of the patients. CONCLUSION: No significant differences were found in glandular or extraglandular manifestations or laboratory test results between Ashkenazi and Sephardic patients, despite their genetic differences. A negative history of sicca symptoms effectively rules out primary Sjögren's syndrome in this cohort. These symptoms may not be volunteered by patients and the large variety of extraglandular involvement patterns and associated conditions observed may dominate the patient's presentation, and mandate physicians' awareness and a high index of suspicion for a timely diagnosis.

Academic Medical Centers↗