Search PubMed⌕ Search

Biomedical subjects

S Friedman

Publications and source records attributed to S Friedman.

At least 163 records · Page 9Linked to original sources
PubMed1995

External cephalic version at term using broad criteria: effect on mode of delivery.

We sought to determine whether external cephalic version (ECV) with tocolytic agents in term patients with breech presentation could safely reduce the incidence of breech-related cesarean sections and vaginal breech deliveries. Four hundred and thirty-two patients with breech presentation at term who fulfilled broad criteria for attempted ECV and a control group of 330 patients with breech presentation at term in whom ECV was not attempted, were retrospectively reviewed. ECV was attempted following an infusion of ritodrine hydrochloride, using either the back flip of Saling and Muller-Holve or the classic forward roll. Following successful ECV, an infusion of oxytocin was administered to fix the head in the pelvis. Of the 432 patients, 311 (72%) underwent successful ECV; 86% delivered vaginally. Cesarean sections were performed in 76% of the patients with unsuccessful ECV and in 64% in whom the version was not attempted (control group). We conclude that ECV at term, using tocolytic agents, when applied to a broad spectrum of patients, is a safe and useful procedure for reducing the incidence of breech presentation, and as a direct consequence, for reducing the incidence of cesarean sections.

Breech Presentation↗
PubMed1994

Regulation of EcoRII methyltransferase: effect of mutations on gene expression and in vitro binding to the promoter region.

EcoRII Methyltransferase (M.EcoRII) which methylates the second C in the sequence CCWGG (W = A/T) is autogenously regulated by binding to the 5' regulatory region of its gene. DNase I footprinting experiments demonstrated that purified M.EcoRII protected a 47-49 bp region of DNA immediately upstream of the ecoRIIM coding region. We have studied this interaction with mutants of the enzyme, in vitro by DNA binding and in vivo by investigating the repression in trans of expression of beta-galactosidase from an ecoRIIM-lacZ operon fusion. Two catalytically active mutants failed to repress expression of the fusion whereas catalytically inactive mutants had repressor activity. However, with one of the catalytically inactive mutants, C186S, in which the catalytic Cys was replaced with Ser, and which bound unmethylated CCWGG sequences, repression could only be demonstrated when those sequences in cellular DNA were methylated by supplying a cloned dcm gene in trans. In vitro binding of the DNA fragment containing the ecoRIIM regulatory region was detected only with the mutants that showed repressor activity, including C186S. Results indicate that down-regulation of the gene in vivo and binding to the promoter in vitro are not dependent on the catalytic properties of M.EcoRII. Mobility shift experiments with C186S also revealed that it could bind either the promoter or unmethylated CCWGG sites, but not both. We conclude that the concentration of unmethylated CCWGG sites controls expression from the ecoRIIM promoter.

Amino Acid Sequence↗
PubMed1994

Inhibition of transcription in vitro by binding of DNA (cytosine-5)-methylases to DNA templates containing cytosine analogs.

DNA(cytosine-5)-methylases form tight complexes at their methylation sites when the target cytosine residue is substituted by analogs such as 5-azacytosine or 5-fluorocytosine. To test whether such complexes can block RNA transcription in vitro, template DNA-containing methylation sites were prepared, in which cytosine residues in either the (+)- or (-)-strand were substituted by the analogs. Such templates, irrespective of the strand in which substitution was made, could effectively block the elongation of RNA at specific sites when complexed with EcoRII methylase. The protein-DNA complex probably prevents the unwinding of the template strands or might directly present itself as a steric block to the advancing RNA polymerase. RNA synthesis was also inhibited at specific sites due to complex formation between azacytosine-containing DNA and two other methylases, HhaI and HpaII. The 3' ends of the interrupted transcripts were mapped and were found to lie within 13-14, 13, and 23 nucleotides of the binding sites on the (-)-strand for HhaI, HpaII, and EcoRII methylases, respectively. Exonuclease III footprinting revealed that the boundaries of the complexed methylases, HhaI, HpaII, and EcoRII, on the (-)-strand were within 2-3, 1-2, and 9-10 nucleotides, respectively, of the last nucleotide copied by the RNA polymerase.

Base Sequence↗
PubMed1994

Mutagenesis of the nuclear localization sequence in EGF-1 alters protein stability but not mitogenic activity.

Fibroblast growth factor (FGF)-1 is able to translocate to the nucleus as an exogenous protein and a deletion of the nuclear localization sequence near the NH2-terminus of FGF-1 (FGF-1(28-154)) yields a recombinant polypeptide with impaired mitogenic activity. To study the significance within this region (NYKKPK), five FGF-1 point mutations were constructed and their recombinant protein forms analyzed. Interestingly, none of the mutant protein products showed a significant reduction in mitogenic activity when compared to wild-type protein. Because these data suggested possible structural instability within the FGF-1(28-154) deletion mutant, protein structure was examined by fluorescence spectroscopy. Indeed, the FGF-1 point mutations which had similar mitogenic activity to wild-type FGF-1 displayed similar thermal fluorescence spectroscopy patterns as wild-type protein, but FGF-1(28-154) exhibited altered fluorometric profiles. However, the mitogenic activity and structural stability of FGF-1(28-154) was dependent upon the method used to purify the recombinant, whereas purification methods did not effect FGF-1(21-154) mitogenic activity. These studies suggest that the reduced mitogenic activity observed in preparations of the FGF-1(28-154) deletion mutant may be the result of structural instability and fluorescence spectroscopy cannot be used to predict FGF-1 stability.

3T3 Cells↗
PubMed1994

Adverse early experiences affect noradrenergic and serotonergic functioning in adult primates.

It has been proposed that certain adverse early experiences may play a role in determining subsequent susceptibility to adult anxiety and affective disorders and this relationship may be the result of altered neurodevelopment of the noradrenergic and/or serotonergic systems. In this study of nonhuman primates, the predictability of foraging requirements for mothers during an early period of their infants' lives was manipulated. When the offspring were young adults, these early manipulations were related to differences in behavioral response to acute administration of two putative anxiety-provoking agents: the noradrenergic probe, yohimbine, and the serotonergic probe, mCPP. These long-term effects of the developmental environment on subsequent pharmacological responsivity suggest that both neuronal systems may be permanently altered by early experiential factors.

Animals↗
PubMed1994

Idiopathic dilated cardiomyopathy in pregnancy.

We report a 34-year-old woman who presented at 21 weeks with cardiac failure due to idiopathic dilated cardiomyopathy. Following refusal of pregnancy termination, she was treated conservatively with good maternal and neonatal outcome.

Adult↗
PubMed1994

Recovery of epinephrine response but not hypoglycemic symptom threshold after intensive therapy in type 1 diabetes.

PURPOSE: Patients with intensively treated insulin-dependent diabetes mellitus (IDDM) exhibit more severe defects in counterregulatory hormone secretion and symptom recognition during hypoglycemia than do conventionally treated patients. In this prospective study in patients with preexisting defects in counterregulation, we examined the induction and reversibility of impaired symptomatic and adrenomedullary responses to hypoglycemia in 5 patients with IDDM (diabetes duration of 2 to 16 years; aged 19 to 36 years; 3 women, 2 men) who were receiving intensive therapy. METHODS: Counterregulatory responses were assessed by using a single-step (approximately 2.8 mmol/L plasma glucose) and multiple-step (from approximately 5 mmol/L to 2.2 mmol/L plasma glucose) clamped hypoglycemia procedure. Patients were first studied after a stable period of conventional insulin therapy (glycosylated hemoglobin [HbA1c] 9.5 +/- 1.2%), then after 3 to 5 months of intensive therapy (HbA1c 6.6 +/- 0.2%), and a third time after resuming conventional therapy (HbA1c 8.7 +/- 0.9%). RESULTS: Intensive therapy was associated with a 44% decline (P < 0.01) in the average plasma epinephrine increase during hypoglycemia, and the plasma glucose level required to stimulate epinephrine secretion fell from 3.7 +/- 0.2 to 3.0 +/- 0.1 mmol/L (P < 0.01). The threshold, but not the magnitude, of the plasma norepinephrine response was similarly altered. Hypoglycemic symptoms also decreased in intensity (by 67%, P < 0.01), and the glucose level required for symptom activation fell from 3.4 +/- 0.3 to 2.7 +/- 0.2 mmol/L, P < 0.01). When conventional therapy was resumed, the abnormalities in the epinephrine response due to intensive therapy were almost completely reversed. However, the reduction in symptoms and the altered thresholds for plasma norepinephrine were not reversed. CONCLUSIONS: There is dissociation between the treatment-associated defects in hypoglycemia counterregulation in IDDM, and an increase in average glycemia produced by a return to conventional insulin therapy is not sufficient to reverse hypoglycemia unawareness worsened by intensive therapy.

Adult↗
PubMed1994

Idiopathic transient osteoporosis of the hip in pregnancy.

OBJECTIVE: To study the nature of a condition called transient osteoporosis of the hip (TOH) in pregnancy. METHOD: Fifty-three cases of this syndrome of unknown etiology have been reviewed and an additional case has been added. RESULT AND CONCLUSION: TOH is characterized by hip joint pain during the 3rd trimester of pregnancy and signs of demineralization of the femoral head. The course is benign with recovery shortly after birth. No specific therapy is required except bed rest.

Adult↗
PubMed1994

Intraligamentary injection of slow-release methylprednisolone for the prevention of pain after endodontic treatment.

The intraligamentary injection of a slow-release steroidal, the anti-inflammatory agent slow-release methylprednisolone (Depomedrol), was compared to a placebo and to an active placebo (Mepivacaine) in preventing postoperative pain after root canal treatment. The results clearly demonstrated that the tested drug significantly reduced the frequency and intensity of postoperative pain sequelae in the experimental set-up.

Adult↗
PubMed1994

Retreatment efficacy 3 months after obturation using glass ionomer cement, zinc oxide-eugenol, and epoxy resin sealers.

The efficacy of ultrasonic retreatment, 3 months after obturation, in conjunction with Ketac-Endo, Roth's 801, and AH26 sealers was evaluated. Seventy-two root canals were prepared and obturated with gutta-percha and one of the sealers mentioned above. After 90 days, the canals were retreated by an ultrasonic technique and the retreatment time was recorded. The roots were split and the amount of debris that remained on the canal walls in three separate levels was scored. Compared by one-way and two-way analysis of variance, the mean scores of remaining debris at the different canal levels for the three sealer groups, as well as for each group, were not significantly different. The only significant difference was found in retreatment time for which Ketac-Endo was significantly slower to retreat than the other two sealers (p < 0.002). Thus, the results of this study showed that the amount of debris remaining on the root canal walls following retreatment 3 months after obturation is similar for Ketac-Endo, Roth's 801, and AH26 sealers, but the retreatment time for Ketac-Endo is significantly longer.

Analysis of Variance↗
PubMed1994

Evaluation of a new rapid quantitative immunoassay for serum myoglobin versus CK-MB for ruling out acute myocardial infarction in the emergency department.

STUDY OBJECTIVE: To compare the predictive values of serum myoglobin and creatine kinase (CK)-MB for ruling out acute myocardial infarction in the emergency department. DESIGN: Prospective, observational study. SETTING: University teaching hospital. PARTICIPANTS: One hundred eighty nine consecutive patients aged 30 years and older who presented within 12 hours from onset of chest discomfort, dyspnea, syncope, congestive heart failure, symptomatic dysrhythmia, pulmonary edema, or epigastric pain were entered into the study. Patients with trauma or renal failure were excluded. INTERVENTIONS: Standardized history and physical examination and blood sampling for serum myoglobin (S-Mgb) and CK-MB were done at the time of presentation (T0) and 1 hour later (T1). RESULTS: Using World Health Organization criteria, 22 acute myocardial infarction patients were identified. Mean time from symptom onset to presentation was 3.2 hours. S-Mgb was more sensitive than CK-MB at T0 and T1, 55% versus 23% (P < .05) and 73% versus 41% (P < .05), respectively. Respective specificities of S-Mgb versus CK-MB were 98% versus 99% (P = NS) at T0 and 97% versus 99% (P = NS) at T1. Negative predictive values of S-Mgb versus CK-MB were 94% versus 91% (P = NS) at T0 and 96% versus 93% (P = NS) at T1. The S-Mgb assay yielded quantitative results allowing the difference between the T0 and T1 values to be analyzed. A difference of 40 or more ng/mL between T0 and T1 was considered positive. When using a positive result in either the T0 or T1 value or a difference between the two values of 40 or more ng/mL, the sensitivity of S-Mgb was 91% (P < .05 versus CK-MB), the specificity was 96% (P = NS versus CK-MB), and the negative predictive value was 99% (95% confidence interval for S-Mgb, 97.0 to 100 versus CK-MB, 95% confidence interval, 88.9 to 96.6). CONCLUSION: In the first hour of presentation to the ED, the rapid quantitative assay for S-Mgb was statistically more sensitive than CK-MB and had an excellent negative predictive value for ruling out acute myocardial infarction in patients with typical or atypical symptoms. Due to the relatively small sample size, we could not exclude the possibility that differences in specificity might become statistically significant (beta error) with a larger sample size of acute myocardial infarction patients.

Confidence Intervals↗
PubMed1994

Increased epinephrine and skeletal muscle responses to hypoglycemia in non-insulin-dependent diabetes mellitus.

We evaluated skeletal muscle counterregulation during hypoglycemia in nine subjects with non-insulin-dependent diabetes mellitus (NIDDM) (HbA1c 9.4 +/- 0.5%, nl < 6.2%) compared with six normal controls, matched for age (51 +/- 3 and 49 +/- 5 yr, respectively) and body mass index (27.3 +/- 1.2 and 27.0 +/- 2.1 kg/m2). After 60 min of euglycemia (plasma insulin approximately 140 microU/ml), plasma glucose was lowered to 62 +/- 2 mg/dl by 120 min. Hypoglycemia induced a 2.2-fold greater increase in plasma epinephrine in NIDDM (P < 0.001), while the plasma glucagon response was blunted (P < 0.01). Hepatic glucose output ([3H-3]glucose) suppressed similarly during euglycemia, but during hypoglycemia was greater in NIDDM (P < 0.005). Conversely, glucose uptake during euglycemia was 150% greater in controls (P < 0.01) and remained persistently higher than in NIDDM during hypoglycemia. In NIDDM, plasma FFA concentrations were approximately fivefold greater (P < 0.001), and plasma lactate levels were approximately 40% higher than in controls during hypoglycemia (P < 0.01); the rates of glycolysis from plasma glucose were similar in the two groups despite a 49% lower rate of glucose uptake in NIDDM (3.4 +/- 0.9 vs. 6.9 +/- 1.3 mg/kg per minute, P < 0.001). Muscle glycogen synthase activity fell by 42% with hypoglycemia (P < 0.01) in NIDDM but not in controls. In addition, glycogen phosphorylase was activated by 56% during hypoglycemia in NIDDM only (P < 0.01). Muscle glucose-6-phosphate concentrations rose during hypoglycemia by a twofold greater increment in NIDDM (P < 0.01). Thus, skeletal muscle participates in hypoglycemia counterregulation in NIDDM, directly by decreased removal of plasma glucose and, indirectly, by providing lactate for hepatic gluconeogenesis. Consequently, in addition to inherent insulin resistance in NIDDM, the enhanced plasma epinephrine response during hypoglycemia may partially offset impaired glucagon secretion and counteract the effects of hyperinsulinemia on liver, fat, and skeletal muscle.

Adult↗
PubMed1994

Characteristics of African-American and white patients with panic disorder and agoraphobia.

OBJECTIVE: The authors explored the clinical characteristics and treatment response of African-American and white patients with panic disorder and agoraphobia who presented for treatment at an anxiety disorders clinic. METHODS: One hundred white and 43 African-American patients were evaluated using a structured interview and completed a variety of standardized rating scales. In addition, data regarding clinical characteristics, psychiatric history, childhood history, life stressors, and treatment outcome were obtained by chart review. The incidence of isolated sleep paralysis was also assessed in a subsample of patients. RESULTS: The two groups had no significant differences in psychiatric symptoms. African-American patients were more likely to use a medical emergency room, to have had childhood separations, and to have had parents who abused substances. They also reported less separation anxiety, school phobia, and affective illness in family members. In addition, African Americans, both patients and nonclinical control subjects, were more likely to report that they experienced repetitive episodes of isolated sleep paralysis. Treatment outcome was moderately successful among both African-American patients and white patients. CONCLUSIONS: Although African-American and white patients show similar symptoms of panic disorder, African-American patients had more unnecessary psychiatric hospitalizations, a higher rate of medical emergency room visits, a higher incidence of isolated sleep paralysis, greater likelihood of childhood trauma, and a greater number of life stressors. Addressing these issues in treatment is critical in reducing the dropout rate and maintaining successful treatment.

Adult↗
PubMed1994

Non-traumatic rupture of kidney in pregnancy--case report and review.

During pregnancy, dilatation of the urinary collecting system is very common. Acute hydronephrosis is one of the most common causes of severe flank pain in pregnancy. Severe complications of hydronephrosis of pregnancy, such as pain, renal failure or a ruptured collecting system, occur very occasionally. A rare case of spontaneous rupture treated conservatively is presented.

Acute Disease↗
PubMed1994

Anxiety disorders in African Americans: an update.

This article discusses issues involved in the diagnosis of anxiety disorders, particularly panic disorder, in African Americans. Although epidemiological studies have shown similar prevalence rates of anxiety disorders among African Americans and non-African Americans, African Americans are underrepresented among those in treatment at mental health settings or serving as clinical research subjects. In addition, few studies have researched the unique demographic, diagnostic, and treatment characteristics of African-American patients with anxiety disorders. Most clinicians therefore are not educated to consider these issues in adapting their treatment approach to affect a more successful treatment outcome for African-American patients with anxiety-disorder. This article identifies and addresses relevant cross-cultural issues.

Adult↗
PubMed1994

Hyperemesis gravidarum. A review.

Hyperemesis gravidarum is a common entity the cause of which has remained poorly defined. However, it probably is a classic example of the interplay between biologic, psychological and sociological variables. Current data on hyperemesis gravidarum and the pertinent literature for the last two decades are reviewed.

Antiemetics↗