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Biomedical subjects

R J Friedman

Publications and source records attributed to R J Friedman.

At least 127 records · Page 7Linked to original sources
PubMed1987

Squamous cell carcinoma of the perineum: management with Mohs' surgical excision and gluteal thigh flap.

Two patients with squamous cell carcinoma of the perineum are presented. The carcinomas were treated by wide local excision using Mohs' fresh-tissue technique for control of the surgical margins. The wounds were closed using a gluteal thigh flap. In 1 patient the flap was extended across the midline for coverage of a contralateral perineal site. Healing was complete in each case. The combination of Mohs' fresh-tissue methods and the posterior thigh flap provided accurate identification and removal of the perineal tumor with stable wound coverage.

Buttocks↗
PubMed1987

Arthroplasty of the ipsilateral shoulder and elbow in patients who have rheumatoid arthritis.

Over a ten-year period, arthroplasty of the ipsilateral shoulder and elbow was performed in thirty-five extremities of thirty-one patients who had advanced rheumatoid arthritis. The results of the procedures were retrospectively reviewed to determine the appropriate sequence of surgery and the functional results that were obtained. All patients were followed for a minimum of two years after the last arthroplasty. The elbow had been operated on first in twenty-one extremities and the shoulder had been operated on first in fourteen. The time-interval between arthroplasties was significantly longer (p less than 0.005) when the elbow had been operated on first (forty-five compared with 13.4 months). All motion of the elbow and elevation and external rotation of the shoulder improved significantly (p less than 0.005), similar to the improvement in motion that is noted when either joint is operated on alone. Also, there was a highly significant reduction in pain and improvement in function (both, p less than 0.001). Review of the roentgenograms of twenty-three patients demonstrated no humeral fractures or interference in the proper placement of the humeral component of the prosthesis either by the stem of the other prosthesis or by the methylmethacrylate. All of the arthroplasties of the shoulder that were performed as the second arthroplasty were done at least five months after the arthroplasty of the elbow, and no dislocations or subluxations of the components of the elbow prosthesis occurred.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Prognostic significance of hypopigmentation in malignant melanoma.

It has been suggested that the presence of cutaneous hypopigmentation favorably influences the prognosis of patients with malignant melanoma (MM). To examine this possibility, we have compared the actual with the predicted survival of 46 patients with MM and hypopigmentation who were among 1130 patients with MM entered in a long-term prospective study of MM at the New York University Medical Center. The actual average five-year survival rate of the patients with MM and hypopigmentation (86.3%) was significantly better than predicted (74.8%) on the basis of the risk factors present in each patient at the time of entry into the study. The findings suggest that hypopigmentation is a factor that beneficially influences the prognosis of MM, and that the mechanisms that inhibit or destroy normal melanocytes in patients with MM may also slow the growth of this cancer.

Humans↗
PubMed1986

Familial malignant melanoma.

Characteristics associated with familial compared with nonfamilial malignant melanoma were assessed. These data were obtained from consecutive prospectively completed questionnaires on 1169 cases of cutaneous malignant melanoma. Of these, 69 patients indicated a positive family history for this cancer. Among the various clinical and histological variables compared, those that significantly correlated with the familial occurrence of malignant melanoma include younger age at first diagnosis, smaller diameter of the lesion, lower Clark level, decreased frequency of nonmelanoma skin cancer, and reduced prevalence of noncutaneous cancer. Increased awareness of malignant melanoma among family members could account for some of these observations. Identification of the familial variety of malignant melanoma has practical implications concerning early detection and prompt intervention.

Age Factors↗
PubMed1986

Anterior transposition for advanced ulnar neuropathy at the elbow.

Previous studies have shown good clinical results after anterior transposition of the ulnar nerve for compression neuropathy. However, it has been suggested that younger patients with a shorter duration of preoperative symptoms benefit most from surgical therapy. To determine what factors adversely affect the prognosis in patients with advanced disease, 23 of 24 anterior transpositions performed consecutively over 6 years were observed at a mean of 33.2 months. The mean age was 52.1 years. Symptoms were present for a mean of 11.3 months. Before the operation, 30% were graded moderate and 70% severe. After the operation, 70% of the patients improved, with 40% having a good result and 30% fair. Advanced age, duration of preoperative symptoms, diabetes, hypertension, alcoholism, etiology, type of transposition, tourniquet time, or atrophy did not predict a poor outcome. Severe clinical findings confirmed by electrophysiologic studies did not contraindicate surgery or preclude a reasonable rate of success in this small but relatively homogeneous group of patients.

Adult↗
PubMed1986

Importance of complete cutaneous examination for the detection of malignant melanoma.

With the rate of melanoma increasing 1,000% in the past 50 years, the early detection of the disease is becoming more important. Data from 2,239 persons seen at the Manhattan Melanoma/Skin Cancer Detection Screening Program were analyzed to determine if a complete cutaneous examination would significantly increase the chance of detecting melanoma. Thirteen of the fourteen melanomas detected were on anatomic sites normally covered by clothing. Patients having complete skin examinations were 6.4 times more likely to have a melanoma detected than those having partial examinations (p = 0.025). These findings reinforce the importance of complete skin examination for the early detection of malignant melanoma.

Basal Cell Carcinoma↗
PubMed1986

Influence of anatomic location on prognosis of malignant melanoma: attempt to verify the BANS model.

Stage I cutaneous malignant melanomas between 0.76 and 1.69 mm thick (Breslow measurement) in BANS (upper part of the back, posterior aspects of the arms, posterior and lateral aspects of the neck, posterior aspect of the scalp) areas have been reported to portend a relatively poor prognosis compared to non-BANS sites. We were unable to confirm the 15% poorer survival for BANS area lesions (84% BANS, 99% non-BANS) originally reported. In this report of 211 patients, malignant melanomas in BANS sites had a 4.6% poorer 5-year cumulative survival rate (88.9% BANS, 93.5% non-BANS; p = 0.35). Although many more patients need to be studied, we believe this small difference in survival is insufficient to influence therapeutic management strategies.

Adult↗
PubMed1986

The dendritic origins of penicillin-induced epileptogenesis in CA3 hippocampal pyramidal cells.

Experiments were performed in order to identify the sites of epileptiform burst generation in rat hippocampal CA3 pyramidal cells. A subsequent slow field potential was studied, which is associated with afterdischarge generation. Laminar field potential and current source-density (CSD) methods were employed in hippocampal slices exposed to penicillin. Simultaneous intracellular and extracellular field recordings from the CA3 pyramidal cell body layer showed that whenever an epileptiform burst was recorded extracellularly, individual CA3 neurons underwent an intense depolarization shift. In extracellular records a slow negative field potential invariably followed epileptiform burst generation. In approximately 10% of slices, synchronous afterdischarges rode on the envelope of this negative field potential. Intracellularly a depolarizing afterpotential followed the depolarization shift and was coincident with the extracellular slow negative field potential. A one-dimensional CSD analysis performed perpendicular to the CA3 cell body layer showed that during epileptiform burst generation large current sinks occur simultaneously in the central portions of both the apical and basilar dendrites. The average distance of the peak amplitude for these sinks from the center of the cell body layer was 175 +/- 46.8 microns and 158 +/- 25.0 microns, respectively. A large current source was recorded in the cell body layer. Smaller current sources were observed in the distal portions of the dendritic layers. During the postburst slow field potential a current sink was recorded at the edge of the cell body layer in stratum oriens--a region referred to as the infrapyramidal zone. Simultaneous with the current sink recorded there, smaller sinks were often observed in the dendritic layers that appeared to be "tails" or prolongations of the currents underlying burst generation. Two-dimensional analyses of these field potentials were performed on planes parallel and perpendicular to the exposed surface of the slice. Isopotential contours showed that the direction of extracellular current is mainly orthogonal to the CA3 laminae. Correction of CSD estimates made perpendicular to the cell body layer for current flowing in the other direction did not alter the location of computed current sources and sinks. In order to show that the dendritic currents associated with epileptiform burst generation were active sinks, tetrodotoxin (TTX) was applied locally to the dendrites where the current sinks were recorded.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMed1986

Ipsilateral hip and femoral shaft fractures.

Over a 20-year period, 24 patients were treated for ipsilateral hip and femoral shaft fractures. The majority of the hip fractures were extracapsular. All resulted from high-energy impaction injuries (motor vehicle accidents and falls from over 15 feet), with 25% being open. There were numerous associated injuries, many requiring multiple operations. One-third had an associated knee injury, with 75% occurring in those with extracapsular fractures. The diagnosis and treatment of three hip fractures were delayed, but all healed without avascular necrosis. Patients were treated by traction and various internal fixation methods, either alone or in combination. Fifty percent had major complications, predominantly patients treated only in traction. At a mean follow-up examination of 9.5 years, two-thirds had a good result and one-third a fair result. Those with extracapsular fractures had the same result as those with intracapsular fractures. Patients treated by fixation of one or both fractures had a significantly shorter hospital stay than those treated by traction alone. Extracapsular fractures have a high incidence (43%) of associated knee injuries. Treating both fractures with internal fixation allows early mobilization, easier patient care, fewer complications, and a shorter hospital stay. Despite the severity of multiple injuries, and the diversity of treatment with many complications, when stability is achieved the patients generally recover good function.

Accidents, Traffic↗
PubMed1986

Relationship of lumbosacral nevocytic nevi to sun exposure in dysplastic nevus syndrome.

In 104 consecutive Caucasian patients who had histologically proved dysplastic nevi, the number and diameter of nevocytic nevi were determined in two equally sized contiguous rectangles in the lumbosacral region. The cephalad (superior) rectangle was in a relatively sun-exposed site, whereas the caudad (inferior) rectangle was in a relatively sun-protected site. Many of the nevocytic nevi identified in these rectangles had the clinical features of dysplastic nevi. Significantly, more nevi were found in the cephalad rectangle compared with the caudad rectangle. Men greater than or equal to 40 years of age had significantly larger nevi in the cephalad rectangle compared with the caudad rectangle. These data are consistent with the hypothesis that sunlight promotes development of more and larger nevocytic nevi in individuals afflicted with dysplastic nevus syndrome.

Adolescent↗
PubMed1986

Hazard-rate analysis in state I malignant melanoma.

Hazard-rate analysis provides a unique means of assessing prognosis in patients with malignant disease. The hazard rate is the probability of a patient dying within a particular unit of time after definitive therapy. Hazard-rate analysis was performed on a series of 719 consecutive patients with clinical stage I cutaneous malignant melanoma (MM). The peak hazard rate for death from metastatic MM occurred during the 48th month of follow-up. Thereafter, the hazard rate declined and approached zero by the 120th month. When the patients were stratified by the thickness of their primary MM, thicker lesions reached their peak hazard-rate month earlier than thinner lesions. We conclude that after 120-month survival, the risk of dying from MM is virtually zero. However, since rare late deaths from MM occur, lifetime follow-up is recommended.

Humans↗
PubMed1986

The use of the computer in the dermatopathology laboratory.

On a regular basis we are upgrading and modifying our software package to meet our ever-changing needs. The day of the user-friendly computer is upon us. We have found the computer to be an ever-important extension of our own minds, truly our own electronic servant. It has relieved us of the mental tedium that in the past has eaten up so much of our time, leaving us free to accomplish the tasks that our electronic servant could never accomplish, including the creation of new ideas and the appreciation and nurturing of old ones.

Accounting↗
PubMed1985

Relationship of nevocytic nevi to sun exposure in dysplastic nevus syndrome.

In eighty consecutive patients who have the dysplastic nevus syndrome, the concentration of nevocytic nevi on the relatively sun-protected lateral thoracic area was compared to the concentration on the relatively sun-exposed areas of the anterior and posterior thorax. Nevocytic nevi in an area 7 X 20 cm were counted in each location. There was a total of 177 nevi on the lateral thorax (average, 2.2 nevi/person), 361 on the anterior thorax (average, 4.5 nevi/person), and 506 on the posterior thorax (average, 6.3 nevi/person). Men showed no significant difference in the number of nevi on the anterior and posterior thoracic areas, but women had fewer nevi on the anterior than on the posterior thoracic sites. These findings are consonant with the hypothesis that sunlight induces nevocytic nevi in patients who have the dysplastic nevus syndrome.

Adult↗
PubMed1985

Refinements in reconstruction of congenital breast deformities.

The use of tissue-expansion prostheses offers significant advantages in the reconstruction of congenital breast deformities, including Poland's syndrome. In the patient who has completed normal breast development, expansion on the abnormal side allows the development of adequate overlying skin and enlargement of the nipple-areola complex. It further allows transposition of the nipple-areola complex to a more normal location. In young patients who have not completed full breast development, tissue expanders have been placed beneath the hypoplastic breast and remain in place for many years. Periodic inflation of saline allows symmetry to be maintained as the opposite breast matures.

Adolescent↗
PubMed1985

Deep inferior epigastric free flap for breast reconstruction after radical mastectomy.

This case illustrates an unusual mastectomy patient in whom the standard alternatives for breast reconstruction were not available. A deep inferior epigastric transverse abdominal free flap was successfully employed. The abundance of tissue provided by this technique enabled reconstruction of a large breast to match the contralateral side.

Abdomen↗
PubMed1985

The versatility of pericranial flaps.

The pericranium is the source of multiple, dependable, well-vascularized flaps which are of use to the plastic and reconstructive surgeon for multiple defects of the face and skull. Based anteriorly, the flap can cover the entire central third of the face or be transposed intracranially to correct abnormalities of the cribriform plate and dura. Based laterally on the temporalis muscle, the flap can be turned to multiple arcs for reconstruction of the face, ear, and intracranial defects. Donor-site morbidity and complications have been minimal.

Adolescent↗