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Biomedical subjects

M J Friedman

Publications and source records attributed to M J Friedman.

At least 73 records · Page 4Linked to original sources
PubMed1992

Age-related psychiatric comorbidities and level of functioning in alcoholic veterans seeking outpatient treatment.

The relationship of age and of level of adaptive functioning to comorbidity of mental disorders among alcoholics was studied in a survey of all alcoholics seeking outpatient mental health treatment in the Veterans Affairs mental health care system during a one-month period in 1986 (N = 22,463). More than half of the alcoholic outpatients had one or more comorbid psychiatric diagnoses. Rates for comorbid substance abuse disorders, posttraumatic stress disorder, schizophrenia, and personality disorders peaked in younger alcoholics and then decreased with age. Age-related increases were observed for major depression, anxiety disorders, and organic brain syndrome or dementia. DSM-III axis V ratings of poor to grossly impaired functioning were consistent across age groups. More than half of alcoholics with a comorbid psychiatric disorder were rated as severely impaired, compared with less than a third of those with no comorbid mental disorder.

Activities of Daily Living↗
PubMed1992

The postoperative knee.

Magnetic resonance (MR) has established itself as the gold standard for noninvasive imaging of the knee. As in arthroscopy, assessment of injuries to the menisci, articular surfaces, synovium, and cruciate ligaments can be made. Additionally, MR has an advantage over arthroscopy in being able to assess the para articular soft tissues and cortical and medullary bony compartments. Until recently, the role of MR in the postoperative knee has been less clear. New information, however, suggests that MR is capable of assessing the status of the partially resected meniscus, the adjacent articular surfaces, and subchondral medullary lesions that frequently occur. There has been recent interest in reestablishment of the stabilizing function of a previously torn anterior cruciate ligament by means of autogenous or allogenous materials. MR permits the surgeon to assess the isometry and possible sites of graft impingement that may occur following cruciate ligament reconstruction. The purpose of this article is to define the current status of MR in the assessment of the postoperative knee.

Bone Transplantation↗
PubMed1991

Partial thickness rotator cuff tears: results of arthroscopic treatment.

Thirty-one patients with arthroscopically documented partial thickness rotator cuff tears treated by arthroscopic debridement of the lesion were retrospectively reviewed. The patients had had symptoms for an average of 20.5 months prior to surgery. Twenty-two of these 31 shoulders also had bursoscopy, with 18 having arthroscopic subacromial decompression. The results were graded by both the UCLA Shoulder Rating Scale and Neer's criteria. Twenty-six (84%) of the patients had satisfactory results with the remaining 5 (16%) patients having unsatisfactory results. A classification system for the size and location of partial thickness rotator cuff tears is presented. The lesion size did not affect the result. Repeat arthroscopy in three patients demonstrated no further deterioration of their rotator cuff. The results with and without subacromial decompression were similar. The need for subacromial decompression is best determined by the arthroscopic finding of a bursal side tear.

Adult↗
PubMed1991

Osteonecrosis of the knee after arthroscopic surgery: diagnosis with MR imaging.

Spontaneous osteonecrosis about the knee typically is a disease of the elderly characterized by an acute onset of pain. The exact cause of this condition has long been debated, although a causative relationship between meniscal tears and spontaneous osteonecrosis about the knee has been postulated. Seven patients with knee pain, meniscal tears, and chondromalacia without initial evidence of osteonecrosis at magnetic resonance (MR) imaging underwent arthroscopic surgery with meniscal recontouring or repair and cartilage shaving. These patients returned within 2-14 months with recurrent pain in the treated knee. MR imaging then demonstrated abnormalities consistent with osteonecrosis. Osteonecrosis of the femoral condyle or tibial plateau may be a late sequela of meniscal injury in association with chondromalacia and arthroscopic surgery. This diagnosis should be suspected in patients with recurrent knee pain after arthroscopic repair of meniscal tears. The precise relationship of this pattern of osteonecrosis to that previously described as spontaneous requires further investigation.

Arthroscopy↗
PubMed1991

A controlled study of alprazolam and propranolol in panic-disordered and agoraphobic outpatients.

We studied the efficacy of propranolol (Inderal) compared to alprazolam (Xanax) in 29 patients with a diagnosis of agoraphobia with panic disorder or panic disorder with or without limited phobic avoidance in a 6-week double-blind controlled experiment. Alprazolam is effective in those syndromes, whereas to date only negative or ambiguous results had been reported for propranolol. Fourteen patients received a mean daily dose of 5.0 +/- 2.3 mg of alprazolam and 15 patients received 182.0 +/- 60.5 mg mean daily dose of propranolol. We found both drugs to be effective to suppress panic attacks and reduce avoidance behavior. The only significant between-drug difference was a more rapid onset of alprazolam's panicolytic effect. Propranolol merits further study. We suggest patients worthy of a clinical trial.

Adolescent↗
PubMed1991

Prosthetic anterior cruciate ligament.

1. All synthetic anterior cruciate ligaments can be divided into three broad categories--permanent, stent, and ingrowth. 2. Theoretical advantages (e.g., potential increased strength, decreased harvest morbidity, time to return to sport, ease of insertion, ease of revision) warrant further attempts to develop synthetic ACLs. 3. Permanent ACLs require 5-year follow-up. Gore-Tex I had 85% to 90% good to excellent results at 2 years. 4. Acceptable failure rates for permanent prosthesis (5 years? 10 years?) should be discussed. 5. Gore-Tex II will represent a significant improvement to Gore-Tex I (increased abrasion resistance). 6. Prosthetic debris and effusions should continue to be analyzed carefully. Dr. Freddie Fu's protocol for retrieval and analysis should be accepted and standardized. 7. LAD. Careful analysis of the control group in U.S. Series II should enable us to determine the "true" contribution of this augmentation device. 8. Leeds-Keio. If biomechanically significant intra-articular tissue is stimulated, this is a potentially attractive prosthetic concept. U.S. clinical studies will start in 1990. 9. Stryker-Dacron. This device appears to have a failure rate similar to that of Gore-Tex I. 10. Six new prosthetic devices are currently under evaluation by the FDA and are in phases I through V.

Animals↗
PubMed1991

Accuracy of diagnoses from magnetic resonance imaging of the knee. A multi-center analysis of one thousand and fourteen patients.

Magnetic resonance images of the knee were made for 1014 patients, and the diagnosis was subsequently confirmed arthroscopically. The accuracy of the diagnoses from the imaging was 89 per cent for the medial meniscus, 88 per cent for the lateral meniscus, 93 per cent for the anterior cruciate ligament, and 99 per cent for the posterior cruciate ligament. The magnetic resonance examinations were done at several centers, and the results varied substantially among centers. The accuracy ranged from 64 to 95 per cent for the medial meniscus, from 83 to 94 per cent for the lateral meniscus, and from 78 to 97 per cent for the anterior cruciate ligament. The results from different magnetic-resonance units were also compared, and the findings suggested increased accuracy for the units that had a stronger magnetic field. Of the menisci for which the magnetic resonance signal was reported to be Grade II (a linear intrameniscal signal not extending to the superior or inferior meniscal surface), 17 per cent were found to be torn at arthroscopy.

Adolescent↗
PubMed1990

SLAP lesions of the shoulder.

A specific pattern of injury to the superior labrum of the shoulder was identified arthroscopically in twenty-seven patients included in a retrospective review of more than 700 shoulder arthroscopies performed at our institution. The injury of the superior labrum begins posteriorly and extends anteriorly, stopping before or at the mid-glenoid notch and including the "anchor" of the biceps tendon to the labrum. We have labeled this injury a "SLAP lesion" (Superior Labrum Anterior and Posterior). There were 23 males and four females with an average age of 37.5 years. Time from injury to surgery averaged 29.3 months. The most common mechanism of injury was a compression force to the shoulder, usually as the result of a fall onto an outstretched arm, with the shoulder positioned in abduction and slight forward flexion at the time of the impact. The most common clinical complaints were pain, greater with overhead activity, and a painful "catching" or "popping" in the shoulder. No imaging test accurately defined the superior labral pathology preoperatively. We divided the superior labrum pathology into four distinct types. Treatment was performed arthroscopically based on the type of SLAP lesion noted at the time of surgery. The SLAP lesion, which has not been previously described, can be diagnosed only arthroscopically and may be treated successfully by arthroscopic techniques alone in many patients.

Accidental Falls↗
PubMed1990

Relationship between utilization of mental health and medical services in a VA hospital.

Previous research has demonstrated a reduction in utilization of medical services following the initiation of psychiatric services for certain patients. The phenomenon has been called the offset effect. The authors investigated the offset effect in a Veterans Administration medical center setting. They found that the offset effect emerged only for patients who had high rates of use of medical services who received mental health services for 1 year or less. They discuss factors related to higher rates of medical care utilization as well as important differences between the present and previous research that require further study.

Age Factors↗
PubMed1990

Acute anterior cruciate ligament reconstruction. Analysis of complications.

One hundred fifty-six patients treated with intraarticular anterior cruciate ligament (ACL) reconstruction were analyzed to determine the incidence of complications. The study group of 31 patients (Group I) was treated with repair or reconstruction of an acute ACL injury. A comparison group of 125 patients had reconstruction for chronic ACL instability (Group II). The patients were evaluated clinically and by roentgenograms. The average follow-up time for the study group was 52.2 months. In Group I, 35% developed fibroarthrosis postoperatively that required arthroscopic lysis of adhesions and manipulation to restore motion. In Group II, only 12% developed this complication. However, developing this complication did not affect a patient's long-term clinical result when properly recognized and promptly treated.

Adolescent↗
PubMed1989

Towards the development of a mathematical model for acupuncture meridians.

Traditional concepts of classical acupuncture and Chinese medicine come from a culture which is very different from ours, and there has been considerable problems in their accurate presentation. Our approach is to attempt the development of a mathematical language that links these traditional concepts theoretically to models that can be experimentally tested. We first review some of Manaka's findings, confirmed also by our results, having to do with low intensity stimuli. In particular, Manaka applied polarized agents such as Cu(+) and Zn(-) to nonacupuncture points on a meridian and to the so called "mother and child" points on a meridian. In both cases he observed the pressure pain reaction which increased for one orientation of Cu and Zn on the meridian and decreased for the opposite orientation. Note that in the case of "mother and child" points the observed reaction was in agreement with the so called "five phase (five element)" theory. Also, in the case of the "mother and child" points the effect usually lasted considerably longer than in the case of nonacupuncture points on a meridian. Taking into account the connection between Manaka's results and skin electrical measurements by some electrodermal diagnostic instruments such as Motoyama's AMI, we discuss some equivalent electric circuits for a single meridian and relate them to the nervous system response. In particular, an electrical circuit model similar to the synapse membrane with two ionic channels seems to be especially useful when we try to explain Manaka's clinical results and Motoyama's results on the velocity of propagation of electrical impulses along meridians. We also develop a mathematical model in the form of a linear five dimensional dynamical system of the so called "five phase (five element)" laws such as "creative" cycle, "controlling" cycle, etc., in the case of a single meridian. We connect this model with the membrane type model mentioned above by assuming a simple mass action law, for the dependence of the conductances in the ionic channels on the input signals. This combined model is used to describe the development of a "disease" and its treatment according to the "five phase" theory. Here we interpret the "disease" as a blockage in a meridian, while the treatment initiates the unblocking process.

Acupuncture Therapy↗
PubMed1989

Intraarticular versus intraarticular and extraarticular reconstruction for chronic anterior cruciate ligament instability.

One hundred twenty-seven patients were evaluated for the results of surgical stabilization in chronic anterior cruciate ligament instability. Eighty-four patients had been treated with intraarticular reconstruction alone, while 43 patients had been treated with a combination of intraarticular and extraarticular stabilization. Patients were evaluated by questionnaire to assess subjective and functional status by clinical examination of objective findings, and by roentgenograms and instrumented ligamentous stability testing. The follow-up interval averaged 45.2 months for the entire group (range, 24-90 months). Using a 200-point scale, the rating for the group treated with intraarticular reconstruction alone was 169.1, while the average rating for the group treated with combined intraarticular and extraarticular stabilization was 166.2. Overall, an excellent or good result was obtained in 67% of patients in the intraarticular only group and in 70% of the patients in the combined reconstruction group. There were no significant differences between the two groups in terms of changes seen on roentgenograms or in terms of residual laxity measured by instrumented testing. Thus, there is no demonstrable benefit derived from combined intraarticular and extraarticular stabilization procedures for chronic anterior cruciate ligament instability, provided that a well-placed intraarticular substitute of sufficient strength is functional.

Adolescent↗
PubMed1988

Evidence for a neutrophil-mediated protective response in malaria.

Zymosan-activated and non-activated human polymorphonuclear neutrophils (PMN) were added to in-vitro cultures of the human malaria parasite Plasmodium falciparum in microtitre wells. Microscopic counting of parasites in Giemsa-stained smears showed that at a PMN:RBC ratio of 1:150, the same as occurs in human malaria, parasites in wells with zymosan-activated neutrophils were suppressed 65%. Determination of parasite nucleic acid synthesis by 3H-hypoxanthine incorporation showed that in wells with PMN:RBC ratio of 1:150 parasite viability was only 22% of control. Various oxygen scavengers were tested for ability to reverse the effects of activated neutrophils on parasite development. Superoxide dismutase (20 mg/ml) and catalase (50 mg/ml) had no effect; tryptophan protected the parasites to a moderate degree while histidine alleviated suppression of parasite development to the greatest extent. This suggests that singlet oxygen is the most effective neutrophil product in killing or suppressing the growth of parasites. We also observed that non-activated neutrophils were activated by parasites and/or their products resulting in killing of newly-released parasites.

Animals↗
PubMed1988

Toward rational pharmacotherapy for posttraumatic stress disorder: an interim report.

There is growing evidence that medication can alleviate symptoms associated with posttraumatic stress disorder (PTSD). Recent research also suggests that PTSD has a unique biological profile consisting of alterations in sympathetic arousal, the neuroendocrine system, and the sleep/dream cycle. This profile distinguishes PTSD from both major depression and panic disorder. Medication appears to alleviate PTSD symptoms associated with sympathetic hyperarousal and intrusive recollections of the trauma but seems ineffective against avoidant symptoms. Pharmacotherapy alone is rarely sufficient to provide complete remission of PTSD. Symptom relief provided by medication facilitates the patient's participation in individual, behavioral, or group psychotherapy.

Anti-Anxiety Agents↗