Biomedical subjects

M J Friedman

Publications and source records attributed to M J Friedman.

152 records · Page 9Linked to original sources

PubMedDate not supplied

Critical analysis of knee ligament rating systems.

Sixty-five patients who consecutively underwent anterior cruciate ligament reconstruction were studied using four individual, categoric, knee score rating systems. Different results were noted at followup (mean, 35 months; range, 24 to 58) depending on the rating method used. Ali patients were graded using the Hospital for Special Surgery, Lysholm, Tegner activity, and Cincinnati Knee Ligament rating systems. The Cincinnati Knee Ligament rating individual scores were noted to be lower than the Hospital for Special Surgery and Lysholm scores for subjective and objective outcome assessment. The Hospital for Special Surgery and Lysholm scores did not correlate highly with the Cincinnati Knee Ligament rating final rating, but they did correlate with each other. The use of ligament rating scores tended to inflate results, particularly when raw scores were converted to overall categoric ratings (e.g., excellent, good). The Cincinnati Knee Ligament rating system correlates more highly with individual grading and most precisely defines outcome in athletically active patients. Sources of error may be introduced by a disproportionate combination of unrelated scores or by overrating low-activity-level individuals who avoid stressing their knees. Avoidance of data generalization remains the optimal method for studying anterior cruciate ligament surgery outcome.

Activities of Daily Living↗

PubMedDate not supplied

Fracture of the proximal tibia with immediate weightbearing after a Fulkerson osteotomy.

The records of 234 people who had anteromedialization of the tibial tubercle with oblique osteotomy between 1983 and 1994 at two separate institutions were reviewed retrospectively. Six patients (2.6%) had fractures of the proximal tibia postoperatively, within 13 weeks of the Fulkerson osteotomy. All fractures occurred after a change in the postoperative physical therapy regimen from partial weightbearing to immediate full weightbearing. All fractures healed with acceptable alignment of less than 5 degrees of varus-valgus or anteroposterior angulation. Given this increase in fracture incidence, a more conservative postoperative physical therapy regimen is recommended. All patients should be nonweightbearing initially, advanced gradually to partial weightbearing, and allowed full weightbearing only after the osteotomy has radiographic evidence of complete healing.

Adult↗

PubMedDate not supplied

Revision anterior cruciate ligament reconstruction surgery.

Revision anterior cruciate ligament (ACL) reconstruction is indicated for selected patients with recurrent instability after a failed primary procedure. The cause of the failure must be carefully identified to avoid pitfalls that may cause the revision to fail as well. Associated instability patterns must be recognized and corrected to achieve a successful result. The choice of graft, the problem of retained hardware, and tunnel placement are the major challenges of revision ACL reconstruction. The patient must have reasonable expectations and understand that the primary goal of surgery is restoration of the ability to perform activities of daily living, rather than a return to competitive athletics. The results of revision ACL reconstructions are not as good as those after primary reconstructions; however, the procedure appears to be beneficial for most patients.

Activities of Daily Living↗

PubMedDate not supplied

An in vitro study of needle force penetration comparing a standard linear insertion to the new bidirectional rotation insertion technique.

OBJECTIVE: The purpose of this study was to determine the effect of a bidirectional rotation insertion technique on the force necessary to puncture and advance a needle through a tissuelike substance. METHOD AND MATERIALS: Two in vitro penetration test models were constructed using different tissuelike substances of different densities. Each tissuelike substance was tested with 30-gauge, 27-gauge, and 25-gauge needles of two brands commonly used in dentistry. The needles were placed to a standardized depth of 0.5 inch (1.27 cm) at a standardized rate of insertion. A customized dental surveyor allowed controlled forces to be applied. A linear insertion technique and a newly described bidirectional rotation insertion technique were tested. The force of puncture and penetration drag was recorded with an electronic digital scale. A total of 400 needle insertions were performed. RESULTS: A multivariate analysis of technique, material, needle gauge, and needle brand revealed the data to be statistically significant, demonstrating no overlap. The post-hoc analysis of between-subject effects found that the needle insertion technique accounted for the most powerful effect in reducing force penetration. The bidirectional insertion technique had the greatest influence on reducing the force penetration irrespective of material, needle gauge, or needle brand tested in this study. CONCLUSION: The bidirectional rotation insertion technique required two to three times less force than did a standard linear insertion technique. A continuous rotation in a single direction would be expected to produce similar results. Needle gauge and needle design have a smaller effect on reducing force penetration than did the technique used during insertion. The in vitro model used in this study represents a reliable dynamic testing system that can be used for future evaluation of needles.

Anesthetics, Local↗

PubMedDate not supplied

Using AMSA and P-ASA nerve blocks for esthetic restorative dentistry.

Esthetic restorative dentistry procedures represent an increasing segment of the services provided by the general practitioner. One important assessment criterion for a successful anterior esthetic restoration is how well it harmonizes with the lips to create a pleasing smile line. Unfortunately, traditional local anesthetic techniques interfere with this assessment by distorting the lips and face during anesthesia. The anterior, middle superior alveolar block and the palatal approach anterior superior alveolar block injections represent two recently defined techniques to anesthetize maxillary teeth effectively without numbness of the face, lips, or muscles of expression. Although safety and efficacy studies are only beginning to emerge, these injections appear to be useful additions to local anesthetic techniques, especially when anterior esthetic restorative procedures are being performed.

Anesthesia, Dental↗

PubMedDate not supplied

1-year followup of cardiac status after adriamycin therapy.

To study the natural history of the alterations in cardiac function produced by Adriamycin therapy, serial M-mode echocardiograms, electrocardiograms, and systolic time intervals were obtained in 15 patients prior to Adriamycin therapy and at 3-month intervals during and 1 year after cessation of therapy. The echocardiographic E-point septal separation increased from a median 0 dose value of 0.40 cm to 0.70 cm (P less than 0.003) at the time of the maximum dose of Adriamycin. The electrocardiographic frontal plane voltage decreased 13% (P less than 0.008) and the pre-ejection period/left ventricular ejection time ratio increased from a median value of 0.37 to 0.40 (P less than 0.01) during this same period. During the first year after Adriamycin was discontinued, no significant change was noted in any of these values. Thus, as a group, the slight deterioration of ventricular function that occurred during Adriamycin therapy remained unimproved during the 1-year followup period.

Adolescent↗

PubMedDate not supplied

Preliminary results with abrasion arthroplasty in the osteoarthritic knee.

A retrospective survey of 110 patients treated by arthroscopic debridement of the knee joint was conducted; 73 of 100 operations included abrasion arthroplasty. The average follow-up period was one year. All patients had Grade IV articular changes. Overall, 60% of the patients who underwent abrasion arthroplasty showed improvement, while the knee was unchanged in 34% and worse in 6%. The results were best in patients younger than 40 years of age. Forty-one patients had medial compartment abrasion in concert with pathologic medial meniscal conditions; 53% of these patients were improved. In a comparable group of 37 patients treated by medial compartment debridement and medial meniscectomy without abrasion only 32% showed improvement. Thus, tentative results in this small series of patients treated by abrasion arthroplasty are encouraging. Further investigations in a larger series are warranted to determine the long-term results of the procedure.

Adult↗

PubMedDate not supplied

Neurobiological sensitization models of post-traumatic stress disorder: their possible relevance to multiple chemical sensitivity syndrome.

Neurological sensitization has been proposed as a model for post-traumatic stress disorder (PTSD) (Lipper et al., 1986; van der Kolk, 1987; Friedman, 1988; Post et al., 1988, 1994; Charney et al., 1993). Laboratory paradigms in which repeated exposure to a discrete stimulus is associated with progressive intensification of a neurophysiologic, behavioral, or pharmacologic response has many parallels with the sequence of events that precipitates PTSD. Investigators with other clinical interests have also been attracted to sensitization models. Specifically, Bell and associates (1992) have proposed that olfactory-limbic kindling is a very good model for understanding the etiology of multiple chemical sensitivity (MCS) syndrome. A number of articles in this volume have addressed the goodness-of-fit between this model and MCS. My major assignment is to review laboratory data and clinical observations pertinent to sensitization models of PTSD. I will show that although there are intriguing parallels between the two phenomena, one must have great respect for the complexity and polymorphism of both sensitization and PTSD before grasping for simplistic theoretical conclusions. Secondly, I will address the following question; if both PTSD and MCS can be understood as sensitization phenomena, are PTSD patients at greater risk to develop MCS and vice versa? This article is divided into four sections: a) a description of three distinct sensitization phenomena; b) a description of the symptoms of PTSD; c) a review of the applicability of sensitization models to the clinical phenomenology of PTSD; and d) a review of the hypothesis that PTSD patients might be more vulnerable to MCS.

Animals↗