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Biomedical subjects

M J Friedman

Publications and source records attributed to M J Friedman.

At least 109 records · Page 6Linked to original sources
PubMed1984

Plasma drug and homovanillic acid levels in psychotic patients receiving neuroleptics.

Plasma neuroleptic and homovanillic acid (HVA) levels are reported for a group of psychotic subjects exhibiting clinical improvement in response to neuroleptic medication. Clinically effective plasma neuroleptic levels, measured by a radioreceptor assay and expressed as either nanomolar concentration of parent drug or as haloperidol equivalents, were different for the seven neuroleptics tested. Plasma HVA, measured by high-pressure liquid chromatography with electrochemical detection (LCEC), increased in response to initiation of neuroleptic treatment and decreased when neuroleptic medication was withdrawn. No correlations were found between plasma neuroleptic level and HVA level or between HVA level and clinical response. Mean therapeutic plasma levels of neuroleptics, expressed as nanomolar concentration of parent drug, correlated with the potencies of the same drug in displacing 3H-dopamine from D-1 and D-2 receptors in rat striatal membranes. This represents the first report that clinically measured plasma concentrations are high enough to displace dopamine from its specific receptors in the CNS.

Animals↗
PubMed1984

Serum dopamine-beta-hydroxylase activity in depression and anxiety.

Three studies were done to determine whether serum dopamine-beta-hydroxylase (DBH) activity is affected by the symptoms of depression or anxiety. In the population-screening study, serum DBH activity was measured in a heterogeneous sample of 548 medical, surgical, and psychiatric outpatients. No association was found between serum DBH activity and scores on either the Zung Self-rating Depression Scale or the Taylor Manifest Anxiety Scale. In the longitudinal depression study, enzyme activity was measured in 14 patients with major depressive illness treated with imipramine. Serum DBH activity remained unchanged throughout treatment whether or not the patient recovered from the depressive illness. Furthermore, there was no association between enzyme activity and steady state antidepressant plasma levels. In the longitudinal anxiety study, evaluation of 45 anxious outpatients in a placebo-controlled double-blind evaluation of two benzodiazepines (diazepam and alprazolam) indicated that serum DBH activity failed to reflect either state changes in anxiety or pharmacological variables. These results are reviewed with respect to current knowledge regarding neuronal release and extraneuronal disposal of circulating DBH.

Adult↗
PubMed1983

Nine standardized scales for evaluating treatment outcome in a mental health clinic.

Analyzed psychometrics of a package of standardized scales used to assess mental health treatment outcomes in a VA cost-effectiveness study (N = 451). Nine scales were derived: Family involvement, involvement with friends, labor market participation, symptomatology (both self-reported and therapist rated), substance abuse (alcohol and drugs), client satisfaction, and client goal attainment. Scales were drawn from several existing instruments, including the Denver Community Mental Health Questionnaire (CMHQ), the Symptom Checklist 90 (SCL-90), the Global Assessment scale, and others. Item-item and item-total correlations showed each scale to have high internal consistency. Principal components analysis demonstrated distinct factors for each scale and good clustering of items within scales. All scale items are discrete choice and have excellent interrater reliability. Validity was corroborated by multiple regression, which showed different scales to be sensitive to different predictors of follow-up status.

Adult↗
PubMed1983

Effects of propranolol on resting and postextrasystolic potentiated left ventricular function in patients with coronary artery disease.

The effect of propranolol on global and segmental left ventricular function at rest and after postextrasystolic potentiation was studied in 12 patients with chest pain. Heart rate was controlled with atrial pacing, and left ventricular cineangiograms were performed before and after 0.15 mg/kg of propranolol. During each ventriculogram a premature ventricular stimulus was introduced by means of a programmed stimulator. Propranolol decreased global left ventricular ejection fraction from 64 +/- 4.5 to 58 +/- 4.6 (p less than 0.03). Postextrasystolic potentiated global ejection fraction was not affected by propranolol (78 +/- 3.5 vs 73.6 +/- 3.4; p = NS). The area ejection fraction of the anteroapical region was decreased after propranolol (64 +/- 4.8 vs 52 +/- 6.5; p less than 0.01); however, the postextrasystolic potentiated area ejection fraction was not affected by propranolol (78 +/- 2.6 vs 71 +/- 4.6; p = NS). Frame by frame analysis of the ventriculograms demonstrated that propranolol depressed global and segmental left ventricular function by affecting the second one-third ejection fraction without influencing the first or third one-third ejection fraction. Propranolol has a small depressant effect on global and segmental left ventricular function in patients with coronary artery disease. Postextrasystolic potentiated global and segmental left ventricular function and early systolic ejection phase indices are not altered by propranolol and therefore may be useful in assessing left ventricular function in patients with coronary artery disease who are taking propranolol.

Cardiac Catheterization↗
PubMed1983

Regional myocardial perfusion at rest and during intracoronary papaverine in patients with coronary artery disease.

Regional myocardial perfusion was measured in 32 patients with the xenon-133 washout technique at rest and after 5 mg of intracoronary papaverine. Areas of decreased perfusion and/or decreased vasodilation were identified visually from computer-generated functional images. The locations of arteries and stenoses, obtained from identically positioned cineangiograms, were overlaid on the functional images. Perfusion rates for 62 myocardial regions were calculated and correlated with the percentage of stenosis. There was no association between degree of stenosis and perfusion at rest. Regional myocardial perfusion increased after papaverine in regions supplied by coronary arteries without stenoses (0% to 25%), 88.6 +/- 4.7 ml/min/100 gm. This increase was significantly greater (p less than 0.001) than the increase in regions supplied by 51% to 75% stenoses (23.7 +/- 6.3 ml/min/100 gm), or 76% to 99% stenoses (12.9 +/- 6.3 ml/min/100 gm), or 100% stenoses (2.5 +/- 3.8 ml/min/100 gm). Thus there was an inverse relationship between the increase in myocardial perfusion stimulated by papaverine and the degree of coronary artery stenosis measured angiographically. In regions supplied by two stenoses in series, vasodilation produced less of an increase than a single stenosis of a similar degree.

Cardiac Catheterization↗
PubMed1983

Control of malaria virulence by alpha 1-acid glycoprotein (orosomucoid), an acute-phase (inflammatory) reactant.

During malaria and other infections, the plasma concentration of alpha 1-acid glycoprotein (AGP) increases 3- to 4-fold, but the function of this glycoprotein has been unknown. This study demonstrates, by in vitro culture of the malaria parasite Plasmodium falciparum, that the AGP concentration achieved during malaria is sufficient to inhibit parasite multiplication by 80%. It was found that the inhibitory activity of AGP depends on and is a function of its sialic acid complement (12-16 mol/mol) and its higher-order structure. AGP acts by blocking parasite-erythrocyte interaction during the invasion process. These findings indicate a function for AGP with definite in vivo significance. Moreover, they reveal an important protective response to malaria and perhaps other infectious diseases.

Animals↗
PubMed1983

The effect of variations of pulsed Doppler sampling site on calculation of cardiac output: an experimental study in open-chest dogs.

We measured aortic flow by two-dimensional Doppler echocardiography in an open-chest dog model to examine how variations in Doppler sample volume length and position influence aortic hemodynamic flow calculations. Fourteen dogs underwent right-heart bypass, in which venous return from the venae cavae drained by gravity to a reservoir. A variable-speed roller pump returned the blood to the pulmonary artery, fixing left-sided cardiac input and output. Echo Doppler measurements were performed using a 3.5 MHz transducer placed directly on the aortic arch to determine internal aortic cross-sectional area. The transducer was then directed to image the aortic arch for Doppler velocity measurements and the various sampling sites were investigated. Doppler cardiac output could then be determined for each of the various sample volumes over a range of known roller pump settings. Doppler velocity was analyzed using fast Fourier transform spectral analysis. Mean velocity over the cardiac cycle was obtained by planimetry of the area under the Doppler velocity curve with a minicomputer. Doppler-derived determinations of cardiac output achieved a correlation of r = 0.98-0.99 to values obtained by the roller pump over a range of cardiac outputs from 0.75-5 l/min. The standard error of the estimate was 0.21/min. In this laminar flow model, there was no difference between the predictive accuracy of any of the sampling sites over the range of roller pump flows. Our study shows that Doppler velocity measurements can be used to quantify aortic flow over a clinically useful range and that variations of sample length and position did not produce significant differences in calculated flows.

Animals↗
PubMed1983

The mitral valve orifice method for noninvasive two-dimensional echo Doppler determinations of cardiac output.

We developed and validated a mitral valve orifice method for Doppler cardiac output determination. In 15 open-chest dogs, cardiac output was controlled and measured by a roller pump interposed between the right atrium and pulmonary artery as a right-heart bypass. Left heart flows were measured in the open-chest dog model by Doppler measurements at the mitral valve orifice and compared not only to volume flow measured by the roller pump, but to electromagnetic flow meters as well. The maximum mitral valve orifice area was measured off short-axis two-dimensional echocardiographic views by planimetry. The maximal orifice was then adjusted for its diastolic variation in size by calculating a ratio of mean-to-maximal mitral valve separation on a derived M-mode echocardiogram. Flow was sampled parallel to mitral valve inflow in a four-chamber plane. The multiplication of mean flow throughout the cardiac cycle by the mean mitral valve area after correction for diastolic size variation yielded a cardiac output determination that could be compared to the roller pump measurement. Fifty-two cardiac output determinations over roller pump values of 1-5 l/min yielded a high correlation between roller pump flows and Doppler (r = 0.97 +/- 0.23 l/min). Our study shows that the mitral valve orifice provides an accurate site for Doppler cardiac output measurements.

Animals↗
PubMed1983

Factor structure and discriminant validity of the SCL-90 in a veteran psychiatric population.

This study tested whether the symptom dimension subscales derived for the Symptom Checklist-90 (SCL-90) by factor analysis could be replicated in a new sample. It was administered to 442 veterans undergoing psychiatric treatment at a VA psychiatric outpatient clinic. Factor analysis using the principal-components method yielded a factor structure different from those previously reported for other populations. The first factor extracted, Depression, explained 37% of the variance of the entire instrument, or more than eight times the variance explained by the second factor. Only five of the nine reported SCL-90 symptom subscales emerged in this study; the Anxiety and Psychoticism subscales disappeared, and the Paranoia and Interpersonal Sensitivity subscales merged. In this population the instrument seems to measure a single global distress factor instead of nine independent symptom subscales as reported previously. This finding was corroborated by the fact that depressed, anxious, and schizophrenic patients showed no differences in SCL-90 symptom profile shapes, although they did differ in overall symptom intensity.

Adult↗
PubMed1982

A new technique for noninvasive evaluation of femoral arterial and venous anatomy before and after percutaneous cardiac catheterization in children and infants.

A new ultrasonic method was applied to image the femoral artery and vein in children for evaluation of short- and long-term effects of cardiac catheterization with femoral percutaneous cannulation. Sixty-six children and infants (aged 5 days to 20 years) were studied with a 9 megahertz electronically focused real time scanner. Adequate studies were obtained in 46 patients before catheterization, in 26 of 30 short-term follow-up studies and in 14 long-term follow-up studies. Femoral arterial size could be quantitatively measured at the inguinal ligament and a correlation existed between imaged femoral arterial diameter and body weight (r = +0.82) or body surface area (r = +0.80). Short-term follow-up ultrasonic imaging studies allowed diagnosis of spasm and other complications of percutaneous femoral arterial puncture. Long-term follow-up studies were performed 4 months to 3 years after catheterization in 14 patients who had no complications recorded at the time of catheterization. These revealed significant differences between vessels on the catheterized and uncatheterized (control) sides in only 3 of the 14. High resolution ultrasonic imaging can provide anatomic and functional information about femoral arteries and veins and appears to be of assistance in planning cardiac catheterization and in studying the short- and long-term effects of percutaneous femoral cannulation.

Adolescent↗
PubMed1982

Left ventricular systolic and diastolic function in hyperthyroidism.

In order to assess the effect of hyperthyroidism on systolic and diastolic function of the left ventricle, M-mode echocardiograms and systolic time intervals were obtained in 13 patients while they were clinically hyperthyroid and again when they were euthyroid following radioactive iodine therapy. Echocardiographic tracings of the septum and left ventricular posterior wall were digitized and analyzed to provide the maximum velocity of shortening and maximum velocity of lengthening. These velocities were normalized for left ventricular diastolic dimension. The left ventricular minor axis fractional shortening and the normalized maximum velocity of shortening were both increased during the hyperthyroid state. The normalized maximum velocity of lengthening, a measure of diastolic left ventricular function, was also increased during the hyperthyroid state when compared to the euthyroid state. The preejection period index and the preejection period/left ventricular ejection time ratio were lower when the patients were hyperthyroid than when they were euthyroid. These data confirm the increased inotropic state and demonstrated increased diastolic relaxation velocities of the hyperthyroid left ventricle.

Adult↗
PubMed1982

High predictive accuracy for detection of left main coronary artery disease by antilog signal processing of two-dimensional echocardiographic images.

Two-dimensional echocardiography has been used to image the left main coronary artery. We have successfully imaged the left main coronary artery in 16 of 19 patients with left main coronary artery disease (LMCAD) and in 14 of 18 control patients using a dynamically focused 3-1/2 MHz experimental phased array sector scanner. Images were displayed with standard logarithmic compression grey scale allocation and with a modified antilog curve which enhances high intensity echoes. All of the 16 patients with LMCAD were identified from the antilog processed image. Only 1 of the 18 control patients had a false positive study. Modified antilog processed images provide high sensitivity (100%) and specificity (93%) for detecting LMCAD. This noninvasive technique could be used to screen patients for the presence or absence of LMCAD.

Adult↗
PubMed1982

Multiclinic controlled trial of diltiazem for Prinzmetal's angina.

To assess the efficacy of a new calcium entry blocker, diltiazem (Cardizem), for prophylaxis of Prinzmetal's angina, 48 patients were studied in randomized, multiple crossover multiclinic study (2 weeks single-blind, 8 weeks double-blind). Diltiazem dosage in one crossover phase was 120 mg per day; in the other, 240 mg per day. Therapeutic response was measured by patients' diary records of angina frequency and nitroglycerin tablet consumption. Treatment with 120 mg of diltiazem per day reduced angina by 41 percent from the entry placebo period and 20 percent from the paired placebo period (p less than 0.005). Treatment with 240 mg of diltiazem per day reduced angina frequency by 68 percent from the entry placebo period and 43 percent from the paired placebo period (p less than 0.01). There were similar reductions in nitroglycerin consumption. Adverse experiences that may have been related to the medication were noted in only 5 percent of patients. There were no alterations in blood pressure or heart rate. The PR interval increased 3 percent at the 240 mg dosage level. We conclude that diltiazem is an effective and safe agent for control of symptoms of Prinzmetal's angina.

Adult↗
PubMed1982

Clinical correlations in patients with acute myocardial infarction and left ventricular thrombus detected by two-dimensional echocardiography.

Eleven of forty-nine patients with acute myocardial infarction had left ventricular thrombus identified by two-dimensional echocardiography. The patients with thrombi had a greater incidence of transmural infarction, high-grade ventricular ectopy on ambulatory monitoring and lower radionuclide ejection fractions than the patients without thrombi. Most of the patients were receiving full-dose heparin and/or warfarin anticoagulation from the time of admission to the hospital. Thus the thrombi either developed prior to hospital admission or developed during anticoagulation therapy. Two patients with thrombi had peripheral emboli complicating their infarction. One of these patients was undergoing anticoagulation at the time of his embolus.

Aged↗
PubMed1982

A series of ten discoid medial menisci.

In a retrospective study, 14,731 menisci were examined to determine the incidence of discoid medial and lateral menisci. Of 8040 medial menisci, ten (0.12%) were discoid. Of 6691 lateral menisci, 102 (1.5%) were discoid. Only 22 discoid medial menisci have been reported in the medical literature. The previously reported cases were analyzed as one series and compared with the present series of ten cases as another. The incidence rate of symptoms in patients older than 18 years of age was 62% in the present series and 65% in the other series. The male to female ratio was three to one in both series. In 38% of the patients in this series trauma preceded meniscal symptoms, as compared with 66% in the literature series. Radiographic abnormalities had been reported in two of the patients reported in the literature, but none were noticed in our series. In both series, all patients recovered following meniscectomy, with the exception of one patient in our series, who developed chondromalacia patella from an unrelated patellar abnormality.

Adolescent↗
PubMed1982

Increased regional myocardial perfusion after intracoronary papaverine in patients after coronary artery bypass grafting.

The objective of coronary artery bypass grafting (CABG) is to increase blood flow to ischemic areas of the myocardium. To determine if this was achieved, anterior wall myocardial perfusion was measured at rest and during intracoronary papaverine (5 mg), with the use of xenon-133 washout in 35 patients. Twelve control patients had no significant diameter narrowing (0% to 25%) of the left anterior descending coronary artery (LAD), 13 patients had greater than 50% narrowing of the LAD, and 10 patients had greater than 50% narrowing of the LAD with patent saphenous vein bypass grafts to the LAD. There was no significant difference in age. LVEDP, and global ejection fraction among the patients. There was no significant difference in anterior wall myocardial perfusion at rest between control subjects (61.0 +/- 3.7 ml/min/100 gm) and non-CABG LAD patients (60.2 +/- 5.4 ml/min/100 gm), or CABG LAD patients (63.4 +/- 4.8 ml/min/100 gm). After coronary arteriolar vasodilatation with papaverine, anterior wall perfusion increased in the CABG patients to 140.6 +/- 6.8 ml/min/100 gm. This was significantly greater (p less than 0.001) than the increase in the non-CABG LAD patients (72.8 +/- 8.1 ml/min/100 gm) but not different from the increase in the control subjects (145.3 +/- 8.4 ml/min/100 gm). In three cases, the same patients were studied before and after CABG with identical results. These data indicate that in patients with coronary disease, increases in myocardial perfusion are limited by the resistance of the proximal stenosis independent of vasodilatation distal to the stenosis. After successful CABG, the patent vein graft restores control of myocardial perfusion to the arteriolar bed.

Angina Pectoris↗