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Biomedical subjects

S Friedman

Publications and source records attributed to S Friedman.

At least 127 records · Page 7Linked to original sources
PubMed1996

Congenital vocal cord paralysis with possible autosomal recessive inheritance: case report and review of the literature.

We describe an infant with congenital vocal cord paralysis born to consanguineous parents. While autosomal dominant and X-linked inheritance have been previously reported in this condition, we conclude that the degree of parental consanguinity in this case strongly suggests autosomal recessive inheritance. Although we cannot exclude X-linked inheritance, evidence from animal studies demonstrates autosomal recessive inheritance and provides a possible molecular basis for congenital vocal cord paralysis.

Adult↗
PubMed1996

Persistent elevations of cerebrospinal fluid concentrations of corticotropin-releasing factor in adult nonhuman primates exposed to early-life stressors: implications for the pathophysiology of mood and anxiety disorders.

There is increasing evidence for an important role of adverse early experience on the development of major psychiatric disorders in adulthood. Corticotropin-releasing factor (CRF), an endogenous neuropeptide, is the primary physiological regulator of the mammalian stress response. Grown nonhuman primates who were exposed as infants to adverse early rearing conditions were studied to determine if long-term alterations of CRF neuronal systems had occurred following the early stressor. In comparison to monkeys reared by mothers foraging under predictable conditions, infant monkeys raised by mothers foraging under unpredictable conditions exhibited persistently elevated cerebrospinal fluid (CSF) concentrations of CRF. Because hyperactivity of CRF-releasing neurons has been implicated in the pathophysiology of certain human affective and anxiety disorders, the present finding provides a potential neurobiological mechanism by which early-life stressors may contribute to adult psychopathology.

Animals↗
PubMed1996

Death on a psychiatric inpatient unit. Effect on a subgroup of schizophrenic patients.

This study documents the effect of an untimely death on a group of patients in a psychiatric inpatient unit. The large community meeting was used as a forum to characterize unique bereavement patterns in a subgroup of schizophrenic patients. Nonschizophrenic patients tended to reach out to obtain comfort and support, but schizophrenic patients showed a heightened sense of vulnerability and expressed distrust and blame toward the staff. We document the interventions that were attempted in neutralizing regression and restoring adaptive coping mechanisms during and after the community meeting.

Adaptation, Psychological↗
PubMed1996

Pressure waves in root canals induced by Nd: YAG laser.

Recently, root canal preparation using Nd:YAG laser has been introduced. Laser interaction with matter may generate cavitation and subsequent pressure waves. This study characterized the pressure waves induced in root canals by either Nd: YAG laser, sonically vibrated files, or ultrasonically vibrated files. The root canals of 14 single-rooted teeth were prepared conventionally and filled with water. In 12 teeth, a pulsed Nd:YAG laser was activated in the canal using optical fibers of various diameters and various power settings. In the remaining two teeth, either a sonic or ultrasonic file was activated. The pressure waves induced in the canals were detected by a piezoelectric transducer. The results were analyzed using correlation coefficient and coefficient of variation. Laser irradiation resulted in pressure waves with amplitudes varying from 35.78 to 79.26 mV, being positively correlated with the laser power density (R2 = 0.870). Sonic and ultrasonic vibrations resulted in pressure waves with mean amplitudes of 60.51 mV and 7.02 mV, respectively. It was concluded that Nd:YAG laser irradiation induced pressure waves, with different characteristics from waves induced by freely vibrating sonic and ultrasonic endodontic instruments when applied to water-filled root canals.

Dental Pulp Cavity↗
PubMed1996

Improved specificity of myoglobin plus carbonic anhydrase assay versus that of creatine kinase-MB for early diagnosis of acute myocardial infarction.

STUDY OBJECTIVE: Carbonic anhydrase III (CA-III) is an enzyme released from skeletal muscle in a fixed ratio with myoglobin during cell injury, but unlike myoglobin it is not found in cardiac muscle. This study compared the clinical utility of serum myoglobin (S-Mgb) in conjunction with the ratio of S-Mgb to CA-III (S-Mgb/CA-III) versus creatine kinase-MB (CK-MB) for the early diagnosis of acute myocardial infarction (AMI). METHODS: This prospective observational study set at a university teaching hospital emergency department enrolled 251 consecutive consenting patients who presented with symptoms consistent with cardiac ischemia or infarction of less than 12 hours' duration. Patients with trauma or kidney failure were excluded. Standardized history and physical examination data were recorded, as were the results of serial blood sampling for S-Mgb, CA-III, and CK-MB at 0, 1, and 3 hours after patient presentation. A positive test for the study assays was defined as an S-Mgb concentration of more than 110 ng/mL with an S-Mgb/CA-III of 3.21 or higher by receiver operating characteristic analysis. Data were analyzed with McNemar's chi 2 test for symmetry and confidence intervals (CIs), using the exact method. RESULTS: Thirty (12%) of the 251 patients were found to have AMI by World Health Organization criteria. Mean time from symptom onset to presentation was 3.2 hours. The use of S-Mgb plus S-Mgb/CA-III compared with CK-MB for identification of AMI in patients presenting within 3 hours of symptom onset yielded respective sensitivities of 47.8% versus 17.4% (P = .02); specificities of 98.9% versus 100% (P = NS); positive predictive values of 84.6% (95% CI, 54.6% to 98.1%) versus 100% (95% CI, 39.8% to 100%); and negative predictive values of 93.5% (95% CI, 90.0% to 96.6%) versus 90.0% (95% CI, 84.8% to 93.9%). CONCLUSION: S-Mgb in conjunction with S-Mgb/CA-III was significantly more sensitive than CK-MB yet equally as specific for the early diagnosis of patients with AMI.

Carbonic Anhydrases↗
PubMed1996

Microalbuminuria as an early predictor of hypertensive complications in pregnant women at high risk.

The value of microalbuminuria in predicting hypertensive complications in pregnant patients at high risk was tested in a prospective trial. A secondary aim was to compare the urinary albumin excretion rate between high risk hypertensive pregnant patients (study group) and pregnant patients at high risk of other complications, normal pregnant subjects, and nonpregnant subjects. Over the last 5 years, 276 patients were studied (142 in the study group v 134 controls). Albumin was measured in an 8-hour overnight urine collection throughout pregnancy using a radioimmunoassay technique. The pregnant women in both the study and control groups demonstrated a statistically significant increase in albumin excretion rate in the second and third trimesters compared with the first. Mean albumin excretion rate values were significantly higher in the study group (P = 0.0001). Using logistic and linear regression models, the presence of microalbuminuria in the early third trimester was proven to be predictive of hypertensive complications (odds ratio, 2.1; confidence intervals, 1.26 to 3.53) and birth weight (R2 = 0.7, P < 0.05) in the study group. Intrauterine growth retardation and neonatal outcome were less predictable. With the introduction of radioimmunoassays and in light of these significant clinical results, we believe that high-risk patients in whom abnormal proteinuria develops usually have a microalbuminuric phase weeks earlier, and this test has some predictive value for severe disease. In addition, the accepted definition of gestational proteinuria should be reconsidered.

Adult↗
PubMed1996

Healing of apical periodontitis in dogs after apicoectomy and retrofilling with various filling materials.

OBJECTIVE: To histologically assess the efficacy of various retrofilling materials in apical surgery. STUDY DESIGN: The pulps of mandibular premolars in seven beagle dogs were infected; this resulted in periapical lesions. Apical surgery was performed without disinfection of the root canals. Super EBA (Harry J. Bosworth Co., Skokie, III.), two formulations of glass ionomer cement, amalgam with varnish, IRM,(Caulk Co., Ltd., Densply International, Milford, Del.) and a light-cured composite resin were the retrofilling materials used. Roots infected and apicoectomized without retrofilling were positive controls. After 6 months the dogs were killed. The experimental roots and surrounding apical tissues were prepared and histologically examined and relative percentages of bone and inflammation were calculated. RESULTS: Super EBA was consistently the best. In overall periapical condition, Super EBA was statistically superior to all materials except IRM. IRM was superior to the glass ionomer cements but not the other materials. As to percentage of bone, Super EBA was the best overall; it was superior to glass ionomer, composite resin, and the positive control but not different from amalgam or IRM. When comparing remaining numbers of inflammatory cells, Super EBA was superior with the lowest number of inflammatory cells present. CONCLUSION: Although not statistically different from IRM, Super EBA was consistently the best retrofilling material tested when compared with all retrofilling materials studied.

Alveolar Process↗
PubMed1996

Connective tissue response to root surfaces resected with Nd:YAG laser or burs.

PROBLEM: The Nd:YAG laser beam may be used for root resection, but the tissue compatibility of the resulting root surface has not been confirmed. OBJECTIVE: This study assessed the connective tissue response over time to implanted root segments with Nd:YAG laser-cut or bur-cut surfaces. STUDY DESIGN: Endodontically treated roots of 25 extracted human teeth were cross sectioned to form 3.5 mm thick disks by alternating a water-cooled Nd:YAG laser with a high-speed water-cooled tungsten fissure bur. A total of 63 disks were implanted into the dorsal subcutaneous tissue of 16 rats, then recovered with the surrounding tissue after periods of 3, 7, 14, 28, 60, and 90 days, and processed for light microscopic examination. Tissue against the cut surfaces was assessed for intensity and extent of inflammation and fibrous capsule thickness. RESULTS: A two-factor analysis of variation showed statistically significant (p < 0.05) differences between the laser-cut and bur-cut surfaces. CONCLUSION: Tissue repair about the root surfaces resected with Nd:YAG laser was delayed when compared with those resected with a bur.

Analysis of Variance↗
PubMed1996

Differential expression of transforming growth factor-beta isoforms and receptors in experimental membranous nephropathy.

In membranous nephropathy (MN) overproduction of matrix by glomerular epithelial cells (GEC) is believed to be responsible for glomerular basement membrane thickening and spikes. We studied experimental MN in rats (passive Heymann nephritis, PHN) at 5, 10 and 30 days. PHN rats exhibited a marked increase in GEC immunostaining for TGF-beta 2 at all time points. TGF-beta 3 staining was increased at day 10 only, and TGF-beta 1 was unchanged. Glomerular mRNA for TGF-beta 2 and -beta 3 was increased by day 5 when urine protein increased, whereas TGF-beta 1 was not. TGF-beta 2 bioactivity was increased at day 5. There was also a marked increase in GEC immunostaining for TGF-beta receptor type I (T beta IR) and TGF-beta receptor type II (T beta IIR) at all time points in PHN. mRNA levels for both receptors increased at day 5. Increases in protein expression and mRNA levels for the TGF-beta 2 and -beta 3 isoforms, and T beta IR and T beta RII were prevented by complement depletion. We conclude that complement-mediated injury to the GEC in vivo is associated with the up-regulation of TGF-beta 2 and -beta 3 isoforms, an increase in TGF-beta 2 bioactivity, and an increase in T beta RI and T beta RII expression. This contrasts with changes in TGF-beta 1 reported in mesangial disease, suggesting that TGF-beta 2 and -beta 3 may be important in diseases of the GEC. The differential expression of TGF-beta isoforms and receptors may be important determinants of the GEC response to injury.

Animals↗
PubMed1996

Race inequities in men's retirement.

A multistate life table model is used to identify how labor force experiences and mortality determine the labor force participation rates (LFPRs) and the qualities of the retirement life cycle of Black and White older men. LFPRs and the life cycle measures are compared to assess inequities of retirement access for the racial groups. The results show that Blacks' lower LFPRs are a function of disability. Despite lower LFPRs than Whites, however, Blacks spend a greater portion of their lives both working and disabled, reducing the retirement period. Race differences in the retirement life cycle also are highly sensitive to mortality. Reducing Black mortality to that of Whites would substantially narrow the life cycle differences. The combination of higher disability and mortality rates among Blacks suggests that health is a key determinant of retirement inequity.

Black or African American↗
PubMed1996

The retained surgical sponge.

OBJECTIVE: A review was performed to investigate the frequency of occurrence and outcome of patients who have retained surgical sponges. METHODS: Closed case records from the files of the Medical Professional Mutual Insurance Company (ProMutual, Boston, MA) involving a claim of retained surgical sponges were reviewed for a 7-year period. RESULTS: Retained sponges occurred in 40 patients, comprising 48% of all closed claims for retained foreign bodies. A falsely correct sponge count after an abdominal procedure was documented in 76% of these claims. Ten percent of claims involved vaginal deliveries and minor non-body cavity procedures, for which no sponge count was performed. Total indemnity payments were $2,072,319, and defense costs were $572,079. In three cases, the surgeon was deemed responsible by the court despite the nursing staff's admitting liability and evidence presented that the surgeon complied completely with the standard of care. A wide range of indemnity payments was made despite a remarkable similarity of outcome in the patients studied. CONCLUSIONS: Despite the rarity of the reporting of a retained surgical sponge, this occurrence appears to be encountered more commonly than generally is appreciated. Operating teams should ensure that sponges be counted for all vaginal and any incisional procedures at risk for retaining a sponge. In addition, the surgeon should not unquestioningly accept correct count reports, but should develop the habit of performing a brief but thorough routine postprocedure wound/body cavity exploration before wound closure. The strikingly similar outcome for most patients would argue for a standardized indemnity payment being made without the need for adversarial legal procedures.

Abdomen↗
PubMed1996

Electronic length measurement using small and large files in enlarged canals.

Electronic apex locators are frequently used attached to a small size endodontic file; however, the effect on the measurement of the relative diameters of the file and the root canal has not been clarified. In this study, the length of enlarged canals was measured using small size files and files matching the canal diameter to observe a possible discrepancy. The accuracy of electronic length control during canal preparation with rotary files was also assessed. The root canals in 21 extracted, single rooted teeth were accessed, and their actual length (AL) established by passing a size 10 file just through the minor apical foramen. The teeth were then embedded in an alginate mold. The initial canal length (IL) was measured with the Root ZX apex locator by negotiating a size 10 file to the apical constriction. The canal was enlarged to size 60 with rotary files while the length was continuously controlled with the apex locator. Then, the final length measurements were obtained with a size 10 file and a size 60 file (FL-10 and FL-60, respectively). The average values of IL, FL-10 and FL-60 were calculated and compared using Repeated Measures Analysis of Variance followed by Tukey's Studentized Range test (P < 0.05). Using composite resin, the size 60 files were secured at the FL-60 length, the teeth were removed from the alginate mold, stained with Picroformal DI Buoin stain and the position of the file tip was observed histomorphometrically after the apical 4 mm of the canal was exposed by grinding the buccal aspect of the root. The IL was 0.45 mm shorter than AL (P < 0.05). The differences between FL-10, FL-60 and IL were not statistically significant. Histomorphometrically, the apical constriction was absent in all the teeth, but the file tips were confined within the root. This study concluded that the Root ZX indicated the location of an apical constriction even when the anatomic constriction was eliminated. In the enlarged canals, length measurements obtained with small and large size files were comparable.

Analysis of Variance↗
PubMed1996

Posttraumatic stress disorder in survivors of the Brooklyn Bridge shooting.

OBJECTIVE: The authors documented the frequency of posttraumatic stress disorder (PTSD) in civilian victims of urban terrorism. METHOD: A recent shooting attack on a van of Hasidic students provided a unique opportunity to document responses of survivors in this targeted group. Eleven of 14 survivors were compared with age-matched subjects on a variety of questionnaires and clinical evaluations. RESULTS: Of the 11 survivors, four were diagnosed with PTSD (all of whom also had concurrent major depressive disorder), one with major depressive disorder, and two with adjustment disorder. CONCLUSIONS: Findings are interpreted in the context of unique factors contributing to the heightened vulnerability of this group.

Adjustment Disorders↗
PubMed1996

Measles vaccination levels of children enrolled in WIC during the 1991 measles epidemic in New York City.

OBJECTIVES: This study assessed measles vaccination rates and risk factors for lack of vaccination among preschool children enrolled in the Special Supplemental Food Program for Women, Infants, and Children (WIC) during the 1991 measles epidemic in New York City. METHODS: Children aged 12 to 59 months presenting for WIC certification between April 1 and September 30, 1991, at six volunteer WIC sites in New York City were surveyed. RESULTS: Of the 6181 children enrolled in the study, measles immunization status was ascertained for 6074 (98%). Overall measles coverage was 86% (95% confidence interval [CI] = +/- 1%) and at least 90% by 21 months of age (95% CI = +/- 1%). Young age of the child, use of a private provider, and Medicaid as a source of health care payment were risk factors for lack of vaccination (P < .001). CONCLUSIONS: During the peak of a measles epidemic, measles immunization rates were more than 80% by 24 months of age in a sample of WIC children. The ease of ascertaining immunization status and the size of the total WIC population underscore the importance of WIC immunization initiatives.

Child, Preschool↗
PubMed1996

Richter's hernia--a surgical pitfall.

BACKGROUND: Although Richter's hernia was first described in 1598, little attention has been given to this topic in recent literature. The diagnosis of Richter's hernia is difficult because of the innocuous development of signs and symptoms and it is associated with a high mortality rate. Awareness of this relatively rare surgical entity is important. STUDY DESIGN: Of 350 patients with incarcerated hernias who underwent operation between 1977 and 1994 at the Department of Surgery "A," Assaf Harofeh Medical Center, 14 had strangulated Richter's hernia. A retrospective study was carried out in order to characterize the clinical manifestations of Richter's hernia and to assess preoperative delay, hospital stay, and complication and mortality rates. A comparison study was made with matched patients with strangulated hernias of non-Richter's type. Differences in morbidity and mortality rates, preoperative delay, and hospital stay of patients with Richter's hernias and the comparison group were evaluated. RESULTS: Of 14 patients with Richter's hernia, seven underwent intestinal resection. The hernia most commonly occurred at the femoral and inguinal sites. Compared with patients with other hernias, patients with Richter's hernias had greater preoperative delay, rate of bowel resection, length of hospital stay, and postoperative morbidity and mortality rates. CONCLUSIONS: Early operative intervention is the mainstay of successful management of Richter's hernia and awareness of this disease and its misleading clinical presentation is of utmost importance.

Adult↗
PubMed1996

Markers for primary care: missed opportunities to immunize and screen for lead and tuberculosis by private physicians serving large numbers of inner-city Medicaid-eligible children.

OBJECTIVE: This study examines coverage levels for immunization, missed opportunities to immunize, and extent of lead and tuberculosis screening in inner-city storefront physician offices and then relates child, visit, and physician characteristics to missed opportunities. METHODOLOGY: With the use of a nested sampling strategy, 232 charts were selected for review in 31 physicians' offices. Charts selected were for children 0 to 35 months of age who had three or more visits in more than 3 months. Physicians were selected from those in specific low-income New York inner-city neighborhoods who submitted large volumes of Medicaid billing claims. Variables examined were missed opportunities to immunize, immunization coverage levels, lead, and tuberculosis screening. The outcome measure was missed opportunities to immunize. RESULTS: Only 26% of the children were up to date for their age for diphtheria, tetanus, pertussis (DTP), oral polio vaccine (OPV), and measles, mumps, rubella (MMR) compared with a city-wide coverage level of 49%. Children who were not up to date for immunization coverage were more likely not to be up to date for lead (RR = 1.24, CI 0.96 to 1.60) or tuberculosis (RR = 1.54, CI 1.14 to 2.08) screening. Physicians miss opportunities to immunize in 84% of the eligible visits. Opportunities to immunize are missed more frequently at sick care or follow-up visits (95% and 91% missed opportunities) than at well care visits (41% missed opportunities). CONCLUSIONS: The quality of pediatric primary care given by these inner-city storefront physicians is suboptimal. Sick and follow-up visits predominate; well care visits are infrequent. If care is to be improved, Medicaid reimbursement policies, which make delivery of well care unprofitable, will need to be changed. In addition, monitoring the quality of care will need to be more aggressive. In the near future children who receive Medicaid in New York will be in managed care. If reimbursement and monitoring policies that provide incentives for delivering pediatric primary care are to be in place, it will be the managed care plans that implement this.

Child, Preschool↗