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Biomedical subjects

S Friedman

Publications and source records attributed to S Friedman.

At least 451 records · Page 25Linked to original sources

The parasitic ecology of the rodent mite, Myobia musculi. IV. Life cycle.

The life cycle of Myobia musculi was determined by daily examination (under anesthesia) of experimentally infested mice. It was found that the larval period lasted 10 days followed by a 5-day nymphal period. Adult forms were seen on the 16th day. Adults produced fertile eggs within 24 hours of their appearance and eggs hatched in 7 days. Thus, the life cycle was completed in 23 days. Application of this information for a successful treatment regimen was discussed. Any treatment which does not kill embryonated eggs must be repeated subsequent to hatching of the eggs but prior to oviposition of fertile eggs by newly hatched females.

Animals↗

Detection of sickle alpha- or beta0-thalassemia by studies of globin biosynthesis.

Globin synthesis studies are useful in the analysis of thalassemia syndromes. We have applied globin synthesis and free alpha-chain pool studies of peripheral blood to characterize hematologic disorders where alpha- or beta-thalassemia was present in combination with HbS or HbC. In 60 non-thalassemic controls, the beta/alpha specific activity ratio was 1.01 +/- 0.06 (SD). In three patients with HbS-beta0-thalassemia, the (betas + gamma)/alpha ratios were 0.48-.067. In four patients with HbSS-alpha-thalassemia, the (BETAS/ALPHA RATIO was 1.26 +/- 0.18 (1.13-1.53). The radioactive free alpha-chain pool in three patients with HbS-beta0-thalassemia was elevated (35.1%-53.0%), while three patients with HbSS-alpha-thalassemia had decreased free radioactive alpha-chain pools (3.2%-6.4%); both were significantly different from the mean (15.1% +/- 2.6%) of the 17 iron-sufficient controls. Simultaneous studies of the fraction of newly synthesized alpha chain contained in the free alpha-chain pool in peripheral blood and bone marrow demonstrated that this fraction was larger in peripheral blood than in marrow, and that the differences between thalassemia patients and controls previously found in bone marrow using these methods were also present in peripheral blood. The results indicate that even when family studies are not possible, patients with HbS in combination with alpha- or beta0-thalassemia can be differentiated from those with homozygous sickle cell disease by globin synthesis and free alpha-chain pool studies using peripheral blood.

Child↗

Artificial donor insemination with frozen human semen.

This study describes the experience with artificial donor insemination (AID) using frozen semen in 227 women who began therapy in 1974 and were followed until March 31, 1976. Ninety-one women (40%) conceived during this period. Sixty-five women (37.9%) failed to continue treatment after three or fewer cycles; follow-up on these patients was incomplete and it is presumed that most did not conceive. The cumulative pregnancy rate was 56.5% among women who persisted in AID for four or more cycles. Additional causes for infertility were found in 53 women. Excluding these, the pregnancy rate was 67.4% for apparently fertile women who had had four or more cycles of AID. Fifty-eight per cent of conceptions occurred within the first three cycles and eighty-five per cent within the first six cycles. The pregnancy rate was not significantly affected by age, occupation, cigarette smoking, or prior fertility. The large number of dropouts after a few cycles of AID suggests a need for intensive and continuous educational, emotional, and psychologic support.

Adolescent↗

Hepatic hemangiomatosis. Successful management by hepatic artery ligation.

Successful management of severe congestive heart failure secondary to a hepatic hemangioma was accomplished by ligation of the hepatic artery in a 2-month-old infant. In the two years since the operation, follow-up observations including liver biopsy and hepatic angiography have indicated complete regression of the tumor. This report provides reassurance that this procedure is effective in the prompt control of severe heart failure, as well as in safely providing time for the spontaneous regression of the vascular tumor.

Follow-Up Studies↗

Diminished bone marrow responsiveness to erythropoietin in myelophthisic anemia.

The purpose of this study was to examine a mechanism which might explain the diminished erythropoiesis that occurs when tumor cells invade the bone marrow (myelophthisic anemia). To this end we compared 21 patients with neoplastic bone marrow invasion with seven normal subjects. When erythropoietin was added to bone marrow cell cultures from the normal subjects, the baseline rate of heme synthesis for a specific number of marrow erythroid cells increased 65%. In contrast, in patients with greater than 60% of the marrow replaced by tumor, the marrow cell culture response to erythropoietin was 14% above baseline. A significant inverse correlation was noted between the degree of marrow infiltration with tumor and the stimulation of heme synthesis with erythropoietin. It is proposed that marrow invasion with tumor may result in decreased marrow response to erythropoietin, and hence, diminished red cell production.

Adult↗

Coronary artery dissection - a complication of cardiac catheterization without sequelae: case report and review of the literature.

This report describes an acute right coronary artery dissection occurring during diagnostic cardiac catheterization. Following catheter manipulation in the vicinity of the aortic valve, the patient complained of mild chest discomfort and had transient electrocardiographic evidence of acute inferior wall myocardial infarction with runs of 2:1 atrioventricular block. Within 5 min, the EKG reverted to precatheterization appearance, and the patient was asymptomatic. Coronary angiography revealed a dissection of the proximal vessel without obstruction. The patient had no clinical sequelae while monitored in the intensive care unit. The patient underwent elective aortic and mitral valve replacement. The area of the dissection was directly visualized, and no abnormality was noted. We review the literature of spontaneous and iatrogenic coronary artery dissections with regard to pathology, diagnosis, and prognosis, and make recommendations for therapy.

Aortic Dissection↗

Transfusion therapy for cerebrovascular abnormalities in sickle cell disease.

Cerebral angiograms were performed in patients with sickle cell disease and symptoms of stroke to evaluate transfusion therapy for cerebrovascular accidents. Three patients who were transfused repeatedly for one year to maintain less than 30% hemoglobin S were compared to two patients who were not transfused. All patients had abnormal angiograms initially. After one year the angiographic abnormalities resolved in two and improved in one transfused child. The two children who were not transfused showed progressive vascular disease. For all arteriograms, the patients were prepared by transfusion with normal red cells and careful hydration.

Anemia, Sickle Cell↗

Variations in globin chain synthesis in hereditary persistence of fetal haemoglobin.

Globin synthesis was studied in four Negro families including 10 members with Hb A-HPFH and four with Hb S-HPFH. The beta/alpha specific activity ratios in 10 of these HPFH heterozygotes were similar to those of the control group. In two patients with Hb A-HPFH, the beta/alpha ratio was slightly decreased in one (0.84) and clearly decreased in another (0.78). In two of the patients with Hb S-HPFH the ratios were clearly decreased (0.71 and 0.75). The extended range of beta/alpha ratios in these 14 patients is similar to that of Negro patients with beta-thalassaemia trait. These studies indicate that a decreased beta/alpha ratio may be found in HPFH, as well as in beta-thalassaemia. Bone marrow globin synthesis was measured in two patients with Hb S-HPFH and decreased peripheral blood beta/alpha ratios, and in one with Hb A-HPFH and a normal peripheral blood beta/alpha ratio. In each patient the (beta+gamma)/alpha ratio of radioactivities as well as the beta/alpha specific activity ratio was close to 1 and therefore balanced, indicating more rapid decay of beta-chain synthesis relative to alpha-chain during red cell maturation or extremely rapid destruction of newly synthesized excess alpha-chains in the bone marrow.

Fetal Hemoglobin↗

Heterozygous beta thalassaemia of unusual severity.

The proband of each of three families of Northern European or Italian extraction had an unusual form of heterozygous beta-thalassaemia, confirmed by haematological, genetic and peripheral blood globin synthesis studies. The unusual severity of this disorder was indicated by chronic haemolysis leading to splenectomy and cholecystectomy, by numerous nucleated red cells and reticulocytes in the peripheral blood, and by leg ulcers in one family. The diversity of clinical expression in many family members with heterozygous beta-thalassaemia was striking. Bone marrow examination in the probands showed numerous large inclusion bodies of the type usually found only in thalassaemia major. In addition, there was unbalanced globin synthesis in the bone marrow, in contrast to the more balanced synthesis found in asymptomatic beta-thalassaemia trait. The amount of newly synthesized alpha-chain found in the free alpha-chain pool was markedly elevated. The unbalanced globin synthesis and alpha-chain inclusions in the bone marrow cells suggest that the severity of the disorder in these patients may be due to the inability of their red cell precursors to fully compensate for the thalassaemic defect or to remove excess alpha-chains. The diversity of clinical expression suggests the influence of undefined acquired or genetic factors on the expression of beta-thalassaemia in these families.

Adult↗

Transatrial resection of the obstructed right ventricular infundibulum.

Obstructions of the right ventricular infundibulum were resected through the orifice of the tricuspid valve in 21 patients, 15 of whom had tetralogy of Fallot. At operation the systolic pressure difference between the right ventricle and pulmonary artery after repair averaged 18 mm Hg (range 0-40 mm Hg). In patients with tetralogy, cardiac index four hours after operation averaged 2.8 L/M2/min. One patient with tetralogy and severe pulmonary hypertension died. Twelve patients with tetralogy were recatheterized 10 to 186 days after operation. The mean systolic pressure difference between right ventricle and pulmonary artery was 23 mm Hg. Residual obstructions were in the pulmonary valvular annulus. Cineangiograms did not show paradoxical motion of the right ventricular wall. Transatrial resection of right ventricular infundibular obstructions carries with it none of the consequences that often follow right ventriculotomy and this surgical approach satisfactorily relieves infundibular obstructions.

Adolescent↗

Mutual visual regard during mother-infant play.

Mutual visual regard was observed in 48 mother-infant dyads during a 6-min. play session. Infant-mother dyads containing 4 mo. -olds displayed significantly more mutual visual regard than dyads containing 6- or 8-mo.-olds. In addition, the more time infants spent in face-to-face interaction with mother, the more smiling they engaged in. No sex difference were observed.

Age Factors↗

Transatrial repair of tetralogy of Fallot.

In 12 months since March, 1975, 25 of 27 patients with tetralogy of Fallot have had corrective operations without ventriculotomy. Infundibular obstructions were excised and ventricular septal defects were closed through a right artiotomy with retraction of the anterior leaflet of the tricuspid valve. Pulmonary valve stenosis was relieved through a pulmonary arteriotomy. In five patients the pulmonary annulus was patched 0.5 to 1.5 cm. into the right ventricle. Immediately after repair peak right ventricular-pulmonary arterial systolic pressure difference averaged 17 mm. Hg and ranged between zero and 40 mm. Hg. Cardiac indices averaged 2.85 L. per square meter per minute 4 hours after operation. All but two patients developed right bundle branch block. One patient with severe pulmonary hypertension died. Fourteen patients have been recatheterized. Right ventricular-pulmonary peak systolic pressure differences ranged between zero and 45 mm. Hg (mean, 22). Cineangiograms show contraction of the free right ventricular wall during systole. Transatrial repair of tetralogy of Fallot is feasible technically in many patients, avoids muscle necrosis and coronary arterial injury, and improves cardiac output in the immediate postoperative period.

Adolescent↗

Mitral atresia with premature closure of foramen ovale. A rare hemodynamic cause for failure of Blalock-Taussig anastomosis to relieve inadequate pulmonary blood flow.

The clinical, hemodynamic, and surgical findings encountered in the management of a hypoxic male infant with a rare and complex variety of cyanotic congenital heart disease associated with inadequate pulmonary blood flow are described. A poor clinical response to creation of a Blalock-Taussig anastomosis led to the discovery of mitral atresia complicated by premature closure of the foramen ovale and partially relieved by the presence of a levoatriocardinal vein. The subsequent creation of an atrial septal defect enhanced the function of the subclavian artery to pulmonary artery anastomosis and provided palliative relief of hypoxia. Some of the clinical and laboratory findings indicating the presence of additional lesions complicating the picture of a tetralogy of Fallot and requiring additional surgical considerations are discussed. The experience indicates that hemodynamic as well as surgical causes may explain the failure of a systemic artery to pulmonary artery anastomosis to function adequately and should be sought.

Cardiac Catheterization↗