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Biomedical subjects

M J Friedman

Publications and source records attributed to M J Friedman.

At least 91 records · Page 5Linked to original sources
PubMed1988

Reconstruction of the anterior cruciate ligament using a torn meniscus.

In eighty of 100 patients, reconstruction of the anterior cruciate ligament using a torn meniscus was successful in restoring stability. The length of follow-up ranged from two to six years and the mean interval from injury to operation was two years. Preoperatively, all but one patient had a positive (2+ or 3+) Lachman test and a positive pivot-shift test. Only ten patients had evidence of major instability, as seen on either test. The result was the same regardless of whether the patient had had a concomitant extra-articular (Ellison) procedure. The results of arthroscopic biopsy in eleven patients did not support the hypothesis that the meniscus underwent metaplasia to ligamentous tissue. Although this procedure yielded results similar to those of other procedures in which autogenous tissues are used to reconstruct the ligament, the meniscus should rarely, if ever, be used for reconstruction of the anterior cruciate ligament. The procedure is indicated only for patients who, in addition to needing reconstruction of the anterior cruciate ligament, also have a torn meniscus that would otherwise have to be totally excised.

Adolescent↗
PubMed1987

Failed arthroscopic meniscectomy: prognostic factors for repeat arthroscopic examination.

The authors have reviewed 44 patients retrospectively who failed arthroscopic partial meniscectomy. The study attempts to define the chances for success and to identify prognostic factors as these patients return for reoperation. Each patient had a repeat arthroscopic examination from 2 to 60 months after partial meniscectomy (average 19 months). They were reviewed an average of 31 months after reoperation (6 to 60 months), and each completed a subjective questionnaire evaluating the efficacy of their repeat arthroscopic surgery. Seventy-one percent of the patients had improvement with reoperation and were classified as good or excellent. Twelve patients (29%) did not improve and were rated poor. Ten parameters, as recorded before repeat arthroscopic examination, were investigated in an attempt to correlate each with success and to find those that are significant prognostic factors. Age of the patient, number of surgeries on the involved knee, time between arthroscopic examinations, nature of history (acute or chronic), workers' compensation or private insurance status, range of motion on physical examination prior to repeat arthroscopy, and degree of chondromalacia as seen at the first surgery were not found to correlate with the ultimate success of the patient. The presence of mechanical complaints before reoperation was a statistically significant parameter that led to a good or excellent result in 86% of the patients at follow-up. Lateral meniscal pathology seen at first partial meniscectomy gave more favorable results than medial meniscal pathology even if the patient had nonmechanical complaints. A history of reinjury between arthroscopic surgeries is helpful only if positive. In the absence of such a history, no conclusion can be drawn.

Adolescent↗
PubMed1987

Patellar instability: treatment by arthroscopic electrosurgical lateral release.

We reviewed the results of arthroscopic lateral release using electrosurgery in 39 patients (45 knees) with a history of recurrent patellar subluxation or dislocation. The average follow-up time was 28 months (range, 24-36). At follow-up, the patients had decreased swelling, instability, and pain. There was an improvement in flexion activities, sports participation, and overall functional ability. Only 20% of the knees had completely normal physical findings: 11.1% of the knees were rated as excellent; 64.4% were improved; and 24.5% were poor. Dislocators had more frequent poor results. The complication rate was 4.4%. There were no postoperative hemathroses. One patient was considered a surgical failure. The technique yields results comparable with those of open extensor realignment procedures and avoids the complications inherent to lateral release in general. The place for this procedure in patellar instability is well-documented.

Adult↗
PubMed1987

Current need versus treatment history as predictors of use of outpatient psychiatric care.

The authors conducted a study of treatment utilization and outcome on a sample of 116 psychiatric outpatients at a Veterans Administration (VA) hospital. Utilization and outcome measures were obtained at a follow-up interview 18 months after a baseline assessment. Comparisons between patients with high and low rates of utilization revealed negligible relationships between use of services and severity of illness, clinical change, or demographics. However, previous use of VA outpatient and inpatient psychiatric services and VA psychiatric disability rating predicted utilization of psychiatric care during the study. The authors conclude that use of VA outpatient psychiatric care may reflect patients' help-seeking history more than their current clinical need.

Female↗
PubMed1987

Integration of VA and CMHC care: utilization and long-term outcome. Community Mental Health Center.

An innovative treatment program was established through which VA outpatient mental health care was decentralized via integration with the CMHC system in northern Vermont. A long-term follow-up study evaluated the success of Veterans' Integrated Community Care (VICC) in meeting its goal of enhanced access to care and better treatment outcomes. Three groups were compared: veterans who were transferred from VA hospital care to VICC care, veterans who were treated at the VA hospital only, and veterans who were newly reached through the VICC program. Follow-ups were conducted 18 months after intake and at least two years thereafter. Results indicate that all groups were improved symptomatically at the first follow-up, but only VICC patients maintained this improvement subsequently. By the last follow-up, VICC patients had reduced their utilization of VA psychiatric care, whereas veterans who had received only hospital-based care had not. VICC treatment represents a viable alternative to centralized VA mental health care.

Adult↗
PubMed1987

Treatment of the anterior cruciate ligament-absent knee with associated meniscal tears. Instrumented testing and clinical evaluation of two patient groups.

The UCLA instrumented clinical testing apparatus was used to measure postoperative stiffness and laxity for two groups of patients with documented chronic absence of the anterior cruciate ligament (ACL) and associated meniscal tears. Group 1 consisted of 76 patients (average age, 25 years) who had undergone anterior cruciate substitution using the torn meniscus, and a second group of 34 patients (average age, 31 years) who had partial meniscectomy alone without ACL substitution. Subjective and objective evaluations were significantly higher and symptoms of pain and buckling significantly lower in the substitution group. In addition, 29% of Group 1 and only 7% of Group 2 patients were able to return to their preinjury sports without limitations, while 5% of the former and 12% of the latter could not return to any sport. At 90 degrees of flexion, there were no significant differences in stiffness or laxity between the patient groups. At 20 degrees of flexion and neutral foot rotation, the meniscal substitution group had an average of 1.4 mm less side-to-side laxity difference than the partial meniscectomy patients; 51% of the substituted patients still had an injured knee laxity that was at least 2 mm greater than the uninjured knee, as contrasted to 67% of the partial meniscectomy patients who exceeded this upper limit of the normal range. At 20 degrees, anterior stiffness of the injured knees of the substitution patients was 28% greater than the injured knees of the partial meniscectomy group; 42% of the substituted patients had an injured knee stiffness within the normal range, while only 18% of the partial meniscectomy patients fell within normal limits. There were no statistical correlations of stiffness or laxity values with clinical scores or patient symptomatology in either group.

Adult↗
PubMed1986

Depressive symptoms in propranolol users.

Depressive symptoms were measured in 34 white male patients receiving propranolol treatment for cardiovascular illness. The Hamilton Rating Scale for Depression and the Hudson Generalized Contentment Scale were used to measure depressive symptoms. Patients with a positive personal or family history of depression had significantly higher depression scores than those with a negative history. Although there was no correlation between propranolol dosage and depressive symptoms for the population as a whole, among patients with a negative history there was a highly significant positive correlation between propranolol dosage and depression scores.

Administration, Oral↗
PubMed1986

Arthroscopy--"no-problem surgery". An analysis of complications in two thousand six hundred and forty cases.

In a retrospective review of 3,261 arthroscopic procedures on the knee, 2,640 met the criteria for inclusion in this analysis. The patients' ages ranged from eight to eighty-three years. There were 1,541 male and 1,099 female patients. Eight hundred and ninety-five of the injuries were work-related. A tourniquet was used in 1,175 procedures and the average tourniquet time was thirty minutes. There were 216 complications over-all (8.2 per cent), 126 being designated as major and ninety-seven, as minor. The major complications that were evaluated were infections, hemarthrosis, adhesions, effusions, cardiovascular, neurological, reflex sympathetic dystrophy, and instrument breakage, and the minor complications were difficulties with wound-healing and ecchymosis. Chi-square analysis showed the following factors to be significant (p less than 0.05). Patients with an industrial injury had a higher rate of neurological complications and reflex sympathetic dystrophy. Diagnostic arthroscopy had the lowest over-all complication rate. Partial medical meniscectomy was associated with a higher over-all complication rate and the highest hemarthrosis rate, and partial lateral meniscectomy was associated with the highest rate of instrument breakage. Abrasion arthroplasty had the highest rate of complications of wound-healing, and subcutaneous lateral release was associated with the most adhesions. The sex of the patient and whether or not a tourniquet had been used had no effect on complications. The experience of the surgeon with arthroscopic procedures also had no correlation with the complication rate. Multiple regression analysis showed that two factors (age and, if a tourniquet was used, the tourniquet time) were dominant predictors of complications. From these data, a model was devised for predicting which patients were at risk for complications and their relative levels of risk. Certain complications may be preventable, and for others the risk factors can be reduced. The high-risk patients in our series were fifty years old or older and had a tourniquet time of sixty minutes or longer.

Adolescent↗
PubMed1985

Evidence for a malarial parasite interaction site on the major transmembrane protein of the human erythrocyte.

Soluble oligosaccharides derived from the surface of human erythrocytes were tested for their ability to competitively inhibit invasion of erythrocytes by Plasmodium falciparum, a malarial parasite. Invasion was most effectively inhibited by erythroglycan, a carbohydrate component of the band 3 transmembrane protein. The lactosamine chains of erythroglycan contributed much of the inhibitory activity. This indication of a primary parasite interaction site on band 3 supports a role for this protein in mediating the radical alterations of the erythrocyte cytoskeleton that accompany invasion.

Anion Exchange Protein 1, Erythrocyte↗
PubMed1985

Arthroscopic partial medial meniscectomy: an analysis of unsatisfactory results.

Results of 150 arthroscopic partial medial meniscectomies were analyzed by computer to identify the factors that lead to an unsatisfactory (fair or poor) outcome. The average follow-up for the group was 36 months (range 24-60 months). One-hundred ten men and 40 women were involved, with an average age of 48 years. The overall results were 58% excellent-good, 28% fair, and 14% poor. Most tears involved the posterior horn (76%). Bucket-handle, longitudinal, and flap tears were rated 88% excellent-good, whereas horizontal cleavage and degenerative and complex tears had only 45% excellent-good scores. The results were adversely affected by the severity of the chondromalacia, work-related injury, prior knee surgery, simultaneous lateral meniscectomy, and increased knee laxity. Because degenerative posterior horn tears had such a high percentage of unsatisfactory results, the question remains as to whether all these tears need to be removed.

Adult↗
PubMed1985

Autogeneic anterior cruciate ligament (ACL) anterior reconstruction of the knee. A review.

Anterior cruciate ligament (ACL) reconstruction with patellar-tendon-bone, semitendinosus/gracilis, iliotibial band, and meniscus have all given "success" rates between 75% and 85% with reasonably short (less than three years) follow-up periods. A 7.9-year average follow-up evaluation of patellar tendon ACL reconstruction would probably represent the overall success rate of the above procedures at 69% good or excellent. All of these procedures require significant dissection and lengthy rehabilitation periods of six months to a year. In attempting to compare these various reconstructions, it is obvious that it will be necessary to develop a consistent and reproducible subjective and objective knee rating system that is presently not used by these authors. Prior to the use of the various prosthetic ACL reconstructions, careful follow-up analysis of the existing body of autogenous ACL reconstructions must be constantly reviewed and assessed in light of the newer data. As Ivar Palmer stated in 1938, "However, it cannot be denied that interferences of this kind are extensive, time-consuming and rather risky, and at the best of times, they cannot result in a restitutio ad integrum."

Bone Transplantation↗
PubMed1985

The management of patients with acute myocardial infarction after successful reperfusion with streptokinase.

Intracoronary streptokinase administration has been an effective procedure for establishing reperfusion of an evolving myocardial infarction by lysing the thrombus that is usually responsible for the infarction. After reperfusion is accomplished, appropriate management of the patient must be planned to provide the best chance for assuring continued vessel patency, and appropriate management of the patient's residual coronary artery disease also must be considered. In selected patients, percutaneous transluminal coronary angioplasty of the residual coronary lesion has been performed successfully immediately following reperfusion with streptokinase. Early coronary artery bypass graft surgery has been performed with good results in other patients. The appropriate management of the patient with acute myocardial infarction is still evolving, and only with additional study and experience will the "best" approach in the management of these patients be defined.

Adult↗
PubMed1984

Serum indole-3-acetic acid in control subjects and newly abstinent alcoholics after an oral loading with L-tryptophan: a preliminary study using liquid chromatography with amperometric detection.

Described in this paper is a rapid, isocratic assay for serum indole-3-acetic acid (IAA). The sample preparation involves only protein precipitation using sulfosalicylic acid, and the sensitivity of amperometric detection is in the picogram range. The chromatographic analysis time is approximately 4 min. The devised method was used for a longitudinal study of IAA levels in serum samples from control subjects and newly abstinent alcoholics. Dietary variations were eliminated by administering a 2.0-g loading dose of L-Trp to all subjects investigated. The results are presented in the form of cumulative frequency polygons. Preliminary data indicate no differences in IAA levels between newly abstinent alcoholics and control subjects.

Administration, Oral↗
PubMed1984

Analytical methodology for assays of serum tryptophan metabolites in control subjects and newly abstinent alcoholics: preliminary investigation by liquid chromatography with amperometric detection.

A rapid, isocratic assay for the determination of all major tryptophan metabolites in serum samples from control non-alcoholic subjects, recovered alcoholics and newly abstinent alcoholics is described. The sample preparation involves only precipitation of protein with sulfosalicylic acid. The complete liquid chromatographic analysis is short (25 min) and the sensitivity of amperometric detection permits the routine assessment of catabolites at the picogram level. This preliminary longitudinal study of the basal and post-tryptophan load serum metabolites revealed a considerable scatter of experimental results for kynurenine and serotonin in all groups examined, probably owing to the clinical heterogeneity of the sample populations.

Adult↗
PubMed1984

Recognition and invasion of human erythrocytes by malarial parasites: contribution of sialoglycoproteins to attachment and host specificity.

The receptivity of human erythrocytes to invasion by Plasmodium falciparum merozoites can be decreased by neuraminidase or trypsin treatment, an observation that supports a role for the erythrocyte sialoglycoproteins (glycophorins) in invasion. We have found that alpha 1-acid glycoprotein (AGP), added to in vitro cultures, can restore invasion of enzyme-treated human erythrocytes. AGP is structurally different from the glycophorins although it does carry 12% sialic acid. Its ability to restore receptivity to desialylated cells is dependent on its sialic acid complement, its concentration, and its binding to the erythrocyte surface. We present evidence that AGP forms a bridge between the merozoite and the enzyme-treated erythrocyte that allows the stronger and more complex interactions of invasion to proceed. We suggest that the glycophorins play the same role on the surface of the intact erythrocyte.

Erythrocytes↗
PubMed1984

Sinus histiocytosis presenting as a mediastinal mass.

A 32-year-old man with a ten-year history of bilateral cervical adenopathy, parotid gland swelling, and a posterior mediastinal mass, presented with headaches. A CAT scan of the head revealed a suprasellar mass. Craniotomy and biopsy of this lesion led to a diagnosis of sinus histiocytosis.

Adult↗