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Biomedical subjects

M Friedman

Publications and source records attributed to M Friedman.

At least 289 records · Page 16Linked to original sources
PubMed1989

Prediction of the presence of ovarian cancer at surgery by an immunochemical panel: CA 125 and copper-to-zinc ratio.

Preoperative levels of the trace elements copper and zinc, in addition to the level of the known marker CA 125, were studied in sera of 32 patients undergoing exploratory laparotomy for suspicion of ovarian cancer and in sera of 49 patients with the diagnosis of ovarian cancer prior to second-look operation. Most patients (63/81) had stage III or IV disease. CA 125 levels greater than 35 U/ml, copper levels greater than 1.5 mg/liter, and zinc levels less than 0.9 mg/liter were considered pathologic. An immunochemical panel composed of CA 125 serum level and ratio of copper to zinc (Cu/Zn) (normal less than 1.65) was found to be most sensitive (98%) in predicting the existence of ovarian cancer before laparotomy, and its overall predictability was 89%. In 14 of 14 patients (100%) who had complete primary surgery for ovarian cancer, the panel was correct in predicting no tumor at second-look operation. In 13 of 14 patients (93%) who had incomplete primary surgery but had no clinical evidence of disease prior to second-look operation, the panel was correct in predicting ovarian cancer. In these two groups of patients, second-look operation could have been replaced by the results of the immunochemical panel.

Antigens, Tumor-Associated, Carbohydrate↗
PubMed1989

Toxicological evaluation of jimson weed (Datura stramonium) seed.

Diets containing 0.5, 1.58 and 5.0% jimson weed seed were fed to male and female rats (20/group) in a 90-day subchronic feeding study. The alkaloid content was 2.71 mg atropine and 0.66 mg scopolamine/g of seed. Gross clinical observations, body weights and feed and water intakes were recorded weekly. Tear production and pupil dilation measurements were made throughout the study. At 90 days, all of the animals were autopsied and clinical-chemistry analyses, complete haematology and bone-marrow evaluation for evidence of clastogenic effects were performed. Tissues from control (0% seed) and high-dose animals were examined histologically. The principal effects of jimson weed seed were: decreased body-weight gain, serum albumin and serum calcium; increased liver and testes weights (as a percentage of body weight), serum alkaline phosphatase and blood urea nitrogen. Female rats showed more marked responses to jimson weed seed than did males. In addition to the effects seen in both sexes, the females developed decreased serum total protein and cholesterol, and increased serum glutamic-pyruvic transaminase and chloride, red blood cell count, haemoglobin concentration and packed red cell volume. No histological lesions were associated with ingestion of jimson weed seed at 5.0%. It is concluded that jimson weed seed at concentrations of 0.5% or more in the diet produced adverse physiological changes in rats.

Alkaloids↗
PubMed1989

Non-clastogenicity in mouse bone marrow of fructose/lysine and other sugar/amino acid browning products with in vitro genotoxicity.

Heated sugar/amino acid reaction mixtures, known to contain products that are clastogenic and/or mutagenic to cells in vitro, were evaluated for clastogenic activity in mouse bone marrow using the erythrocyte micronucleus assay. Heated (i.e. browned) fructose/lysine reaction mixtures were also evaluated in the Salmonella his-reversion assay and the Chinese hamster ovary (CHO) cell chromosomal aberration assay to confirm and extend previous in vitro observations. Significant mutagenicity of fructose/lysine mixtures was observed in Salmonella typhimurium strains TA100, TA2637, TA98 and TA102, with greater activity in mixtures heated at pH 10 than at pH 7. S-9 decreased the activity in strains TA100, TA2637 and TA98, but increased the activity in strain TA102. Both pH 7 and pH 10 reaction mixtures of the fructose/lysine browning reaction were highly clastogenic in CHO cells. Heated mixtures of fructose and lysine, and of glucose or ribose with lysine, histidine, tryptophan or cysteine, did not increase the frequency of micronucleated erythrocytes in mice when administered by the oral route. This indicates the absence of chromosomal aberrations in erythrocyte precursor cells, and indicates that the genotoxic components of the browned mixtures are not absorbed and distributed to bone marrow cells in amounts sufficient to induce micronuclei when given orally. Because sugar/amino acid browning reactions occur commonly in heated foods, it is important to evaluate further the in vivo genotoxicity of browning products in cell populations other than bone marrow.

Animals↗
PubMed1989

Inclusion body myositis associated with progressive dysphagia: treatment with cricopharyngeal myotomy.

A 68-year-old man known to have inclusion body myositis underwent a cricopharyngeal myotomy in an attempt to improve his progressive dysphagia. Morphological studies from tissues obtained during this procedure showed the diagnostic features typical of this chronic inflammatory myopathy. To our knowledge this is the first pathological demonstration of inclusion body myositis involving the pharyngeal skeletal musculature.

Aged↗
PubMed1989

Effects of a health activist course on knowledge and awareness of antibiotic use.

A cohort study investigated the specific outcomes of a health education coursed carried out by recently graduated physicians in an urban primary care setting in Israel. Questionnaires were used to study the effects of the programme on knowledge and awareness concerning antibiotic usage. The results showed a significant gain in knowledge about the causes of infectious disease, appropriate duration of antibiotic intake, side effects of antibiotics and the importance of compliance. In contrast with other studies, low income blue collar workers with less than high school education showed the most significant gains from the programme. Inexperienced physicians were able to implement a community health education programme with clearly defined goals.

Anti-Bacterial Agents↗
PubMed1989

Sleep in patients with spontaneous panic attacks.

Twenty-four drug-free patients with a DSM-III diagnosis of panic disorders (and their age- and sex-matched normal controls) slept in the laboratory for 3 consecutive nights. Panic patients showed a slightly longer sleep latency and a lower sleep efficiency than their normal controls. They also had more overall movement time and more body movements during stage 2 sleep. Eight panic attacks were recorded arising out of sleep. Six of them occurred in the transition phase between stage 2 and stage 3 sleep. The nocturnal panic attacks of these patients are unique, different from stage 4 sleep terrors, and different from dream anxiety attacks.

Adolescent↗
PubMed1989

Variability in doctors' problem-solving as measured by open-ended written patient simulations.

The uncertain validity of written simulations could be due to the difficulty in setting criteria for optimal performance. Usually criteria are set by definition of a limited number of 'correct answers' by a panel of experts reached through an open discussion. This is an artificial situation which entails mutual influence and forces the participants to respond to the necessity to reach a consensus. In the present report we describe an attempt to set 'correct answers' by the independent performance of 15 board-certified internists on four written simulations. There was a marked variability in responses due to legitimate differences in approach, to obvious errors in interpretation of the provided data and to possible differences between the expert behaviour in a real life and in a simulated setting. We believe that the criteria for acceptable performance on written clinical simulations should be determined by independent experts, rather than by a group consensus. Students who receive after the examination a compiled list of options selected by experts in response to the same questions may obtain a more realistic insight into the complexity of clinical problem-solving.

Clinical Competence↗
PubMed1989

Dose response to ipratropium as a nebulized solution in patients with chronic obstructive pulmonary disease. A three-center study.

We performed a dose-response study of ipratropium bromide as a nebulized solution in patients with stable chronic obstructive pulmonary disease (COPD) using a double-blind crossover format. Five doses from 0.05 to 0.6 mg of ipratropium bromide as a nebulized solution, the standard dose of ipratropium bromide by metered-dose inhaler, 40 micrograms, and placebo were given in random order on separate days. End points were the maximal increase in FEV1 and FVC, and the area under the FEV1 and FVC curves in the 8 h after administration of each of the seven treatments. Forty-two patients completed all seven study days. By each of the above end points for FEV1, 0.4 and 0.6 mg of nebulized ipratropium bromide achieved significantly more bronchodilatation than did each of the other treatments. These two doses were not significantly different from each other, suggesting that the optimal dose in this patient population is 0.4 mg. After this dosage, the FEV1 increased by 440 +/- 194 (mean +/- 1 SD) ml at peak effect between 1 and 2 h, and significant bronchodilatation persisted for 6.5 h. Ipratropium bromide by metered-dose inhaler (40 micrograms) was equivalent to approximately 0.1 mg by nebulized solution and achieved only 63 to 73% of the bronchodilatation achieved by optimal doses of the nebulized solution. In terms of FVC, all treatments with ipratropium were significantly better than with placebo. The area under the FVC curve was significantly greater after 0.4 and 0.6 mg of nebulized solution than after other treatments. No significant adverse experiences occurred with any of the treatments.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Inhalation↗
PubMed1989

Implantation of a recurrent laryngeal nerve stimulator for the treatment of spastic dysphonia.

Spastic dysphonia, a rare speech disorder, is characterized by strained phonation with excessively adducted vocal cords. Recurrent laryngeal nerve section, botulinum toxin injection into the vocalis-thyroarytenoid muscle complex, and other techniques have been used to treat this disorder. We have used percutaneous electrical stimulation of the recurrent laryngeal nerve with good results. Previous dog studies demonstrated the relative safety of an implantable recurrent laryngeal nerve stimulator. In this study, we directly stimulated the recurrent laryngeal nerve and vagus nerve in a dog without change in cardiorespiratory status. A Medtronic peripheral nerve stimulator was implanted in a patient with abductor spastic dysphonia. The cuff electrode was positioned around the recurrent laryngeal nerve and stimulation resulted in improvement in her voice. Extensive cardiopulmonary monitoring did not reveal any adverse response to stimulation and there was no discomfort to the patient. On the basis of the good results of this preliminary study, further study with long-term follow-up is under way.

Adult↗
PubMed1989

Transmissibility and treatment failures of different types of human papillomavirus.

In order to evaluate the transmissibility and treatment failures of different types of human papillomavirus (HPV), we obtained biopsy specimens from genital lesions related to HPV in 113 women prior to laser therapy. Sixty-eight had condylomata acuminata, 14 had flat condyloma, and 31 had cervical intraepithelial neoplasia with or without condylomata. Of 76 male sexual partners examined colposcopically, 58 (76%) had HPV-related lesions. All biopsy specimens were analyzed for specific type of HPV DNA by Southern blot hybridization with probes for HPVs 6, 11, 16, and 18. Sixty-one women had HPV 6 or 11 (6/11), 40 had HPV 16 or 18 (16/18), and in 12 the analysis was negative for these types of viral DNA. Deoxyribonucleic acid analysis of biopsy specimens from recurrent lesions showed the same type of viral DNA as in the primary lesion. Significantly more male partners (28 of 47) with the same HPV type were found among women with HPV 6/11 than among women with HPV 16/18 (P less than .005). Patients with HPV 16/18 had significantly more recurrences (14 of 40) after laser therapy than patients with HPV 6/11 (six of 60) (P less than .001).

DNA, Viral↗
PubMed1989

[Epiglottitis in the adult. A proposition for a clinical classification and therapeutic strategy].

Because lack of criteria for staging and treatment of epiglottitis can lead to unnecessary morbidity and mortality, we have introduced a staging system for early classification and appropriate management of adult epiglottitis patients. We retrospectively staged 20 adults with epiglottitis to see in their final outcome would have been altered using our protocol. We found that staging and management according to our protocol were appropriate and possibly could have reduced mortality from 10% to nearly 0%.

Adult↗
PubMed1989

Management of imperforate hymen with the carbon dioxide laser.

A method for the management of imperforate hymen using carbon dioxide laser is described. In four patients presenting with imperforate hymen, the hymen was excised by CO2 laser under local anesthesia. No bleeding or wound infection occurred, and healing was prompt and satisfactory. Two out of four patients became sexually active and experienced no introital dyspareunia. We conclude that the CO2 laser may be an alternative method of treatment for this rare congenital abnormality.

Adolescent↗
PubMed1989

Instruments and equipment for endoscopic sinus surgery.

It is the fiberoptic endoscope and its related hardware that distinguish endoscopic sinus surgery from previous techniques. Lens angles of 0, 25, and 70 degrees, comprising a representative telescope set, accommodate virtually any endoscopic sinus procedure, diagnostic or therapeutic, with unsurpassed visualization. Each telescope may be fitted with an optional suction-irrigation adaptor, a highly controversial accessory among endoscopic surgeons. The clinical situation often dictates the optimal combination of equipment, anesthesia, and technique; surgeon's preference is equally influential. Mastery of conventional operative techniques combined with thorough endoscopic skills is essential for consistent, effective, and safe surgical performance.

Endoscopes↗
PubMed1989

Difficult decisions in endoscopic sinus surgery.

Sinus disease, like many other problems in otolaryngology, may run the gamut of being either easily correctable with a clear-cut treatment or completely resistant to any form of treatment. Fortunately, many patients have problems somewhere between these two extremes. Clearly there is no one correct approach for treatment of many problems. Two, three, or even four approaches may be equally effective in some cases. In other cases, one approach may be successful in the hands of one surgeon whereas another approach is more appropriate for a different surgeon. This article presents nine cases that do not have clear-cut solutions. In some, the consultants clearly disagreed, whereas in others there was some uniformity in treatment plans. This flexibility in surgery in general and specifically with a technique that is relatively new is what makes it so exciting and so promising for continued success in treating sinus disease.

Adult↗
PubMed1989

The effect of a temporary nasoantral window on mucociliary clearance. An experimental study.

Although many studies have clearly shown that nasoantral windows do not help ciliary clearance of sinus disease, studies have not addressed the possible adverse effects of nasoantral windows. This study was performed to determine if an inferior antrostomy can actually improve ciliary clearance. Even with the advent of endoscopic sinus surgery we need to have a better understanding of inferior antrostomies.

Animals↗