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Biomedical subjects

M J Friedman

Publications and source records attributed to M J Friedman.

At least 145 records · Page 8Linked to original sources
PubMed1977

On the safety of long-term treatment with lithium.

Thirteen patients with bipolar affective illness who had received lithium therapy for 1-5 years were tested retrospectively for evidence of cortical dysfunction. Data on patients younger than 55 show no abnormalities on the Halstead-Reitan Neuropsychological Battery and suggest that chronic lithium therapy is relatively safe. Significantly elevated Halstead Impairment indexes were observed among elderly patients, but these data are difficult to interpret.

Adolescent↗
PubMed1977

Relationship between age and tricyclic antidepressant plasma levels.

Older depressed patients treated with imipramine or amitriptyline developed higher steady-state plasma levels of imipramine, desipramine, and amitriptyline. In imipramine-treated patients this finding was associated with a decreased rate of drug elimination from plasma. These findings provide at least a partial explanation for the increased susceptibility of the older patient to tricyclic antidepressant side effects and also provide a pharmacological rationale for use of lower dosages in this age group.

Administration, Oral↗
PubMedDate not supplied

MR imaging and metallic implants for anterior cruciate ligament reconstruction: assessment of ferromagnetism and artifact.

Magnetic resonance (MR) imaging is contraindicated for patients with certain ferromagnetic implants, primarily because of potential risks related to movement or dislodgment of the devices. An additional problem with metallic implants is the potential image distortion that may affect the interpretation of the MR study. Since MR imaging is frequently useful for the evaluation of postoperative anterior cruciate ligament (ACL) reconstruction, the ferromagnetic qualities and artifacts associated with MR imaging were determined for five metallic orthopedic implants commonly used for this surgery. Only the Perfix interference screw displayed a substantial deflection force and caused extensive signal loss. Images of the knee of one patient with two Perfix screws in place were not interpretable because of the image distortion caused by these implants. Therefore, alternative nonferromagnetic implants should be considered for reconstruction of the ACL.

Anterior Cruciate Ligament Injuries↗
PubMedDate not supplied

Depression and hypertension.

The study consisted of 1101 Caucasian, male outpatients, who were screened for depression and hypertension in order to test the hypothesis that there is a unique relationship between these two illnesses. Depression was assessed by the Zung Self-Rating Depression Scale (SDS) while diastolic blood pressure (BP) was accepted as the index of hypertension. Medical records were reviewed to determine whether the patient's clinical diagnoses would have an effect on any relationship between depression and hypertension. It was found that there was no correlation between elevated scores on the Zung SDS and diastolic BP. The diagnosis of anxiety, however, was significantly associated both with depression and hypertension.

Adult↗
PubMedDate not supplied

Relationship of psychiatric status to Gulf War veterans' health problems.

OBJECTIVE: A growing body of research has shown that there are important links between certain psychiatric disorders and health symptom reporting. Two disorders in particular (posttraumatic stress disorder (PTSD) and major depression) have been the most widely implicated to date, and this association has sometimes been used to explain the occurrence of ill-defined medical problems and increased somatic symptoms in certain groups, most recently Gulf War veterans. METHODS: Structured psychiatric diagnostic interviews were used to examine the presence of major psychiatric (axis I) disorders and their relation to health symptom reporting in a well-characterized, stratified subset of Gulf War veterans and a non-Gulf-deployed veteran comparison group. RESULTS: Rates of most psychiatric disorders were substantially lower than national comorbidity estimates, consistent with prior studies showing heightened physical and emotional well-being among active-duty military personnel. Rates of PTSD and major depression, however, were significantly elevated relative to the veteran comparison group. The diagnosis of PTSD showed a small but significant association with increased health symptom reports. However, nearly two-thirds of Gulf participants reporting moderate to high health symptoms had no axis I psychiatric diagnosis. CONCLUSIONS: Results suggest that rates of psychiatric illness were generally low with the exception of PTSD and major depression. Although PTSD was associated with higher rates of reported health problems, this disorder did not entirely account for symptoms reported by participants. Factors other than psychiatric status may play a role in Gulf War health problems.

Cohort Studies↗
PubMedDate not supplied

Acute posterior cruciate ligament injuries.

One hundred and two posterior cruciate ligament injuries were reviewed (43 chronic and 59 acute repairs). The 59 acute repairs were profiled as to cause and site of injury, associated ligamentous damage, clinical examination, patient position at surgery, and reoperation rate. Twenty-two patients were followed up. Motor vehicle accidents and athletics were the usual causes of injury. In the 59 acute repairs, the posterior cruciate avulsion site was femoral in 21, midsubstance in 13, and tibial in 25. The high incidence of associated injuries included medial collateral ligament tears, capsular damage, lateral knee component damage, and anterior cruciate ligament ruptures. Thirteen of 59, believed to have isolated tears, had surgery in the prone position. Twelve were subsequently reoperated. Eight of 12 reoperations were done prone initially for an "isolated" tear. Our acute knees with poor results all had the most supposed "isolated" and midsubstance tears, and the most popliteal surgery. The posterior cruciate ligament tear is due to major violence with associated ligament injuries and has no single universal physical sign. Arthroscopy and examination under anesthesia are recommended to prevent the missed diagnosis (chronic case) or to clarify a suspected "isolated" tear prior to prone popliteal surgery.

Accidents, Traffic↗
PubMedDate not supplied

Arthroscopic "second look" at the GORE-TEX ligament.

We performed an arthroscopic "second look" in 21 knees (20 patients) that had arthroscopic implantation of the GORE-TEX prosthesis for chronic ACL insufficiency. Arthroscopy was done on eight knees at the time of screw removal, eight for knee pain, two for giving way, and three for recurrent effusions. The degree of synovial joint reaction, graft synovial ingrowth, and graft rupture was graded. Microscopic examination was carried out on all biopsies of the GORE-TEX ligament. The average patient age was 30 years and the average time interval from original implantation to second look was 11 months. The GORE-TEX was intact in 11 knees, 10% ruptured in 6, and completely ruptured in 4. There was no correlation between number of GORE-TEX strands ruptured and synovial reaction. No particles of the graft were noted in the synovium if the implant was intact, but particles were noted with graft rupture. We conclude that the intact GORE-TEX ligament is an inert substance and does not cause significant joint reaction. Impingement in the intercondylar notch appeared to be the most common cause of graft failure. Further study is critical to determine the natural history of the GORE-TEX ligament and the knees' response to this prosthetic device.

Arthroscopy↗
PubMedDate not supplied

Four to ten year followup of unreconstructed anterior cruciate ligament tears.

Both operative and nonoperative methods have been advocated for the treatment of ACL tears. However, the optimum management of this injury remains controversial. In the present study, patients treated nonoperatively were evaluated retrospectively 4 to 10 years after ACL tears were documented by arthroscopy and by mild to moderate pivot shifts under anesthesia. Forty-nine patients who underwent arthroscopic evaluation of the knee between 1976 and 1982 were found to have complete tears of the ACL. A mild to moderate pivot shift was present under anesthesia. One or both menisci were torn in two-thirds of the knees, requiring partial meniscectomies. The average age of the patients was 27 years (range, 16 to 46 years). Because of persistent disabling instability, 9 patients (18%) underwent late ACL reconstruction. The remaining 40 patients were evaluated at an average of 5.6 years after documentation of the tear (range, 4 to 10 years). At followup, 25 (62%) of the 40 patients had satisfactory subjective results. Eight of the patients (20%) had returned to their preinjury level of athletic activities without restrictions, and 10 (25%) functioned at the same level but with symptoms, some patients requiring bracing. Seventeen patients (43%) had diminished their level of sports activities, while 5 patients (12%) had given up all sports. Only 2 patients required late meniscectomies. On physical examination, 27 patients (87%) had pivot shifts. Instrumented laxity testing revealed an injured to normal difference of 3.1 mm with a 20 pound force. Radiographic studies were interpreted as normal in 35% of the knees, whereas 65% demonstrated mild degenerative changes.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

Arthroscopic treatment of anterolateral impingement of the ankle.

We studied 31 patients (17 females, 14 males; average age, 34) with more than 2 years of followup who had chronic anterolateral ankle pain following inversion injury. All had failed to respond to at least 2 months of conservative treatment and had negative stress radiographs to rule out instability. On physical examination, tenderness was localized to the anterolateral corner of the talar dome. Magnetic resonance imaging was the most useful diagnostic screening test, showing synovial thickening consistent with impingement in the anterolateral gutter. At an average of 24 months after injury, all patients underwent ankle arthroscopy, which showed proliferative synovitis and fibrotic scar tissue in the lateral gutter, often with associated chondromalacia of the talus. Operative arthroscopic treatment consisted of partial synovectomy with debridement of scar tissue from the lateral gutter. Postoperatively, patients walked with crutches allowing weightbearing as tolerated. Average return to sports was 6 weeks. Histopathologic analysis performed on the resected tissue showed synovial changes consistent with chronic inflammation. Results of treatment after at least 2 year followup were 15 excellent, 11 good, 4 fair, and 1 poor. Since there are several distinct causes of chronic ankle pain, we prefer to call this problem "anterolateral impingement of the ankle" and believe the term "chronic sprain pain" should be discarded.

Ankle Injuries↗
PubMedDate not supplied

Arthroscopically assisted anterior cruciate ligament reconstruction with the pes anserine tendons. Comparison of results in acute and chronic ligament deficiency.

Fifty anterior cruciate ligament-deficient knees treated consecutively with arthroscopically assisted reconstruction using a pes anserine tendon autograft were retrospectively studied. The mean followup was 36.7 months (range, 26 to 58). All patients had reconstruction with a double-stranded graft. The mean injury to surgery interval was 9.6 days in 22 patients (acute group) and 22.5 months in 28 patients (chronic group). Objective outcome, which was noted to be more optimal in the acute group, was better than subjective outcome in either group. Examination revealed 95% of patients treated acutely and 82% of those treated later to have 1+ or less Lachman test result (P < 0.036) and 96% of the acute group and 82% of the chronic group to have an absent pivot shift (P < 0.036). Eighty-eight percent of acutely treated patients had a KT-1000 result of < or = 3 mm, as compared to 61% of chronically treated patients (P < 0.001). Loss of range of motion was significantly greater in the acute group (P < 0.018). Using a strict overall rating system, patients reconstructed earlier were noted to have a better outcome compared to those after delayed reconstruction (P < 0.021). Cumulative meniscal injury appears to be the most significant contributing factor.

Acute Disease↗