Biomedical subjects
Publications and source records attributed to M Friedman.
Mesenteric vein thrombosis in a pregnant woman taking an oral contraceptive is reported. It is presumed that the hypercoagulable state of pregnancy combined with hormonal contraception led to the thrombosis.
The bilobed deltopectoral advancement flap is a versatile reconstructive option for selected cervical defects. This modified version of Bakamjian's classic deltopectoral flap utilizes thin anterolateral neck skin to cover complex anterior neck defects. It offers the safety of a minimally rotated pedicle to reduce the chance of flap necrosis from kinking, and the convenience of a single-stage procedure. We have used this flap six times in our clinical experience. Typically, the defects were located in the anterior cervical region, and many of them were reconstructed following total laryngectomy and radical neck dissection. There was no incidence of flap necrosis in the patients, including those who had had preoperative irradiation.
Three hundred post infarction participants who had received type A behavioral counseling in the Recurrent Coronary Prevention Project, (RCPP) agreed to be followed for 1 additional year after stopping 4.5 years of continuous type A behavioral counseling. One hundred fourteen participants who had served for 4.5 years as controls in the RCPP Study, thus receiving no type A behavioral counseling, volunteered to receive such counseling for 1 year. Eleven of the 300 previously type A counseled RCPP participants were lost to follow-up at the end of the additional year. The remaining 289 subjects at risk were found to have maintained their previously reduced intensity of type A behavior. Their previously observed relatively low cardiac recurrence rate during the additional year also did not significantly change. Ten of the 114 previous control RCPP participants were lost to follow-up at the end of the additional year. The remaining 104 subjects who had received a year's type A behavioral counseling showed a significantly reduced intensity of type A behavior and a similar significant decrease in both the cardiac mortality and morbidity rate. These results suggest that the decline in the intensity of type A behavior and also in the cardiac recurrence rate previously observed in post infarction subjects exposed to type A behavioral counseling persists for at least 1 year after cessation of such counseling.
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Active Na+ absorption by the epithelia that line the airways can drive volume from the airway surface. Exposure of the lumen-facing surface of airway epithelia to amiloride inhibits Na+ transport. Consequently, aerosolized amiloride may help hydrate the desiccated surface liquid that characterizes lung diseases such as cystic fibrosis. We studied the acute cardiovascular and pulmonary effects of amiloride in anesthetized dogs. Intravenous amiloride reduced blood pressure and increased ventilation frequency and airways resistance of the dog. The effects were dose-related (ED50 = 1.3 X 10(-6) mol/kg), resembled those of injected histamine, and were antagonized by methapyrilene. These results were compatible with the release of endogenous histamine by amiloride, but the graded dose-effect relationship for amiloride differed from the quantal relationship induced by the prototypical releaser, 48/80. Aerosolization of a Ringer's solution that was nearly saturated with amiloride deposited, in upper airway surface liquid, drug concentrations which in previous studies, were sufficient to inhibit Na+ transport by canine airways (ED50 approximately 10(-6) M). Cardiovascular function, airways resistance, and indices of pulmonary tissue water, gas exchange, and perfusion were not affected. Since circulating amiloride after aerosolization was estimated to fall below the concentration that induced vasodepression and correct circled bronchoconstriction after intravenous injection, we conclude that the potency of aerosolized amiloride to induce acute effects in tissues other than airway epithelia is no greater than that of intravenous drug.
We have previously demonstrated that a 2H exposure of cultured pulmonary endothelial cells to ozone (0.0-1.0 ppm) in-vitro resulted in a concentration-dependent reduction of endothelial prostacyclin production (90% decrease at the 1.0 ppm level). Ozone-exposed endothelial cells, incubated with 20 uM arachidonate, also demonstrated a significant inhibition of prostacyclin synthesis. To further examine the mechanisms of the inhibition of prostacyclin synthesis, bovine pulmonary endothelial cells were exposed to 1.0 ppm ozone for 2H. A significant decrease in prostacyclin synthesis was found within 5 min of exposure (77 +/- 36% of air-exposed control values, p less than 0.05). Endothelial prostacyclin synthesis returned to baseline levels by 12H after ozone exposure, a time point which was similar to the recovery time of unexposed endothelium treated with 0.5 uM acetylsalicylic acid. Incubation of endothelial cells, previously exposed to 1.0 ppm ozone for 2 hours, with 4 uM PGH2 resulted in restoration of essentially normal prostacyclin synthesis. When endothelial cells were co-incubated with catalase (5 U/ml) during ozone exposure, no inhibition of prostacyclin synthesis was observed. Co-incubation with either heat-inactivated catalase or superoxide dismutase (10 U/ml) did not affect the ozone-induced inhibition of prostacyclin synthesis. These data suggest that H2O2 is a major toxic species produced in endothelial cells during ozone exposure and responsible for the inhibition of endothelial cyclooxygenase activity.
When a nutritionally complete basal diet containing 10% protein from casein was supplemented with 20% protein from unheated casein, wheat gluten or soy protein isolate, weanling mice exhibited significantly increased weight gains. In contrast, weight gains were markedly reduced compared to those with the basal diet; that is, growth was inhibited, when the supplement was soy protein or gluten that had been heated at 200 or 215 degrees C for 72 min in the dry state to stimulate crust baking. Addition of various carbohydrates to the gluten during heating prevented such growth inhibition. After heating with sodium ascorbate (but not L-ascorbic acid), soy protein (at 200 degrees C) and gluten (at 215 degrees C) completely prevented growth when added to the basal diet. Growth inhibition also occurred with a heated casein-ascorbate mixture, but was less than with the other proteins. The extent of growth inhibition increased sharply with temperature of heating in the range 180-215 degrees C and with sodium ascorbate concentration in the range 1-20%. Possible physical and chemical changes during heating of protein-ascorbate mixtures are discussed, as are possible mechanisms for the growth inhibition.
Rat feeding studies showed that L-cystine, L-cysteine, N-acetyl-L-cysteine and L-methionine enhance the nutritional quality of raw (unheated) soy flour as measured in rats by the protein efficiency ratio (PER). Pancreas weights of rats fed diets supplemented with sulfur amino acids were higher than those of rats fed unsupplemented diets. In some instances this increase resulting from nutritional improvement of the diet was relatively greater than that in total body weight. Explanations are offered for these effects in terms of the proposed biofeedback mechanism involving the gastrointestinal endocrine system and the hormone cholecystokinin. The observed stimulation of pancreatic growth by added sulfur amino acids may be closely associated with this pancreatic regulatory mechanism when activated in response to dietary trypsin inhibitors present in unheated soy protein. The extent to which pancreatic hypertrophy develops as a result of a given exposure to trypsin inhibitors may be limited when the total amount or quality of the protein in the diet is less than optimal.
Undergraduate medical students of the Ben Gurion University were evaluated upon completion of their fourth- and sixth-year medical clerkships by a 17-item rating scale, a multiple choice question (MCQ) test and a patient-oriented oral examination by two academic staff members. Pearson's correlation coefficient between the fourth-and sixth-year global ratings was r = 0.44 (P less than or equal to 0.001), while that between the fourth- and sixth-year MCQ scores was r = 0.54 P less than or equal to 0.001). Pearson's coefficient between the global ratings and the MCQ scores in the sixth year was r = 0.25 (P less than or equal to 0.05). Stepwise regression analysis revealed that the ratings on the parameters 'reliability', 'knowledge', 'organization', 'diligence' and 'case presentation' were the most predictive of the overall global rating. It is concluded that the reproducibility of 'subjective' expert assessment of performance through global rating scales is comparable to that of 'objective' evaluation through written MCQ, even though these measures assess different domains of competence at different levels of simulations. It is recommended that the clinical performance of undergraduate medical students should be assessed by a combination of subjective and objective measures.
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Bovine pulmonary endothelial cells grown in vitro were shown to release a factor that was mitogenic for pulmonary smooth muscle cells during exposure to a reduced oxygen tension atmosphere. The addition of hypoxic endothelium-derived medium resulted in a 60% increase in smooth muscle cell number after 24 h of exposure. Addition of medium from pulmonary endothelium exposed to normoxic conditions or medium derived from either hypoxic or normoxic aortic endothelium did not result in significant increases in smooth muscle cell number. Physicochemical characterization of the hypoxic pulmonary endothelial cell-derived factor(s) showed that it was resistant to heat and reducing agent treatment and stable between pH 3 and 10. The mitogenic activity decreased by 71% at pH 2 and by 68% after treatment with trypsin. The activity adhered to DEAE Sephadex. Gel filtration chromatography of the hypoxic-conditioned medium demonstrated 2 major peaks of smooth muscle cell growth factor activity corresponding to molecular weights between 6,000 and 14,000 and 20,000 and 65,000 daltons, respectively. These data suggest that this pulmonary endothelial cell-derived smooth muscle cell peptide mitogen(s) may be involved in the smooth muscle cell proliferative response seen with chronic alveolar hypoxia.
In many clinical situations, the etched-porcelain veneers can provide a restoration that looks natural with a minimum of tooth preparation. Application has been equally successful on mandibular and maxillary teeth. Periodontal response to the veneers, when properly placed, has been excellent.
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The Data Base Management System for community diagnosis was used during two academic semesters with 80 baccalaureate nursing students. At the end of the two semesters the DBMS was evaluated from feedback obtained through faculty discussions, final student papers and oral presentations. The DBMS met the goals established to evaluate the tool. The clarification of categories for essential data is an ongoing process.
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Hepatocellular carcinoma is a rapidly fatal disease in most patients. In addition, many patients have underlying liver disease complicating their treatment. Prognostic factors have been found that identify a subset of patients who could benefit from therapy; though to date, chemotherapy, administered either intravenously or intra-arterially, has not altered the survival of patients who have advanced or recurrent disease. Patients with unfavorable prognostic factors, such as poor performance status, jaundice, or overt liver failure, should be offered only supportive care. Treatment with intravenous doxorubicin may be considered in better risk patients outside a clinical trial, although it has limited activity (less than 20 per cent response rate). Good performance status patients should be placed in clinical trials exploring both new ways to deliver therapy and promising new drugs.
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A wide variety of benign tumors present in the oral cavity. These tumors are for the most part rare and are classified by the tissue of origin. Although benign oral cavity tumors are not life-threatening, they can result in extensive loss of soft tissue and/or bone. Furthermore, many patients are subject to the threat of recurrence, multiple surgical procedures, and the possibility of malignant degeneration. Because many tumors vary little clinically, an adequate biopsy specimen must be obtained for diagnosis. Radiographs are, in general, nondiagnostic. Collaboration with an experienced pathologist is necessary to determine the tumor's probable clinical behavior. Therapy, which is dictated by tumor type, is almost always surgical.