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Biomedical subjects

L Friedman

Publications and source records attributed to L Friedman.

At least 37 records · Page 2Linked to original sources
PubMed1992

Closing in on a breast cancer gene on chromosome 17q.

Linkage of early-onset familial breast and ovarian cancer to 11 markers on chromosome 17q12-q21 defines an 8-cM region which is very likely to include the disease gene BRCA 1. The most closely linked marker is D17S579, a highly informative CA repeat polymorphism. D17S579 has no recombinants with inherited breast or ovarian cancer in 79 informative meioses in the seven families with early-onset disease (lod score 9.12 at zero recombination). There is no evidence for linkage heterogeneity in the families with early-onset disease. The proportion of older-onset breast cancer attributable to BRCA 1 is not yet determinable, because both inherited and sporadic cases occur in older-onset families.

Base Sequence↗
PubMed1992

Catch-up saccade amplitude is related to square wave jerk rate.

Mean catch-up saccade (CUS) amplitude and square wave jerk (SWJ) rate during pursuit were recorded in 20 normal controls, 23 patients with schizophrenia, and 15 patients with affective disorder, using infrared oculography. Target speed during pursuit was 5 degrees/sec. An especially robust correlation was noted in normal controls between SWJ rate during pursuit and mean CUS amplitude (Spearman's rs = 0.87, P less than 0.0001). This correlation also was present in the psychiatric patients (rs = 0.53, P = 0.0006), although it was significantly weaker than in normal controls (P less than 0.02). There were no significant differences between the patient groups regarding the strength of the relationship. Furthermore, similar strong correlations between SWJ rate during fixation and mean CUS amplitude also were found for normals (rs = 0.73, P = .0002) and both patient groups combined (rs = 0.52, P = 0.0009). The results suggest that saccadic intrusions during tracking tax the saccade correcting system, delaying correction for the position error that accumulates when gain is less than 1.0.

Adult↗
PubMed1991

A model of smooth pursuit performance illustrates the relationship between gain, catch-up saccade rate, and catch-up saccade amplitude in normal controls and patients with schizophrenia.

Smooth pursuit eye-tracking performance of 37 unmedicated patients with schizophrenia and 45 normal controls was recorded with infrared oculography, and digitized for off-line analysis of gain and other measures. Target velocity was 5 degrees/sec. Patients with schizophrenia had significantly lower gain than normal controls, confirming several earlier reports. During low gain smooth pursuit tracking, when eye velocity is slower than target velocity, the saccadic system corrects for the accumulating position error with catch-up saccades (CUS). The rate of CUS and the median CUS amplitude were compared between groups. Patients had significantly more CUS than controls, but the median CUS amplitudes were not significantly different. A nonlinear mathematical model of the relationship between gain, CUS amplitude, and CUS rate during steady-state constant velocity tracking was developed to integrate these findings. According to this model, for a given gain, correction for position error can result from either a few large CUS or many small CUS. The fit of the model to empirical data, as assessed graphically and with linear and nonlinear regression techniques, was excellent. The model fit the data for both patients and controls. The psychiatric eye-tracking literature is discussed from the perspective suggested by the modeled relationship.

Adult↗
PubMed1991

Quantitative assessment of smooth pursuit gain and catch-up saccades in schizophrenia and affective disorders.

The smooth pursuit responses to 5 degrees and 20 degrees/sec constant-velocity stimuli were recorded from 23 patients with schizophrenia, 16 affective disorder patients, and 21 normals using low-noise infrared oculography. Pursuit gain, catch-up saccade (CUS) rate and amplitude, and their interrelationships were examined. Gain in the schizophrenic patients was reduced only at 20 degrees/sec, but for both patient groups, CUS rate at 5 degrees/sec was significantly lower than in normals. Using CUS rate at 20 degrees/sec, the patient groups could be distinguished from each other (the rate for schizophrenic patients being highest, and the rate for affectives the lowest) but neither differed significantly from normals. The diagnostic groups did not differ significantly in mean CUS amplitude, although there was a trend for patients to have larger saccades. Gain-CUS rate correlation was strong in normals but reduced or absent in both patient groups. These results indicate that the ocular motor systems of patients with schizophrenia and affective disorders process eye position error abnormally.

Adult↗
PubMed1991

Prefrontal sulcal prominence is inversely related to response to clozapine in schizophrenia.

The object of this study was to determine if brain computed tomography (CT) scan measures are related to treatment response to clozapine, an atypical antipsychotic drug that is effective in some therapy-resistant schizophrenic patients. Thirty-four therapy-resistant patients were evaluated with the Brief Psychiatric Rating Scale (BPRS) before and after 6 weeks of treatment with clozapine. The patients were classified into Nonresponders, Moderate Responders, and Good Responders based on the percent change in BPRS. Comparison of these groups on prefrontal sulcal prominence (PSP) indicated a statistically significant linear trend, with nonresponders having the highest, moderate responders an intermediate degree, and good responders the least PSP. There were no linear trends for the ventricular-brain ratio (VBR), and no quadratic trends for either brain measure. A similar linear trend relating PSP to four of five BPRS subscales, including both positive and negative symptoms, was observed. The relationship between PSP and treatment response was also assessed with multiple linear regression, and PSP significantly contributed to prediction of BPRS at 6 weeks. The results are discussed with regards to the hypothesis that the effect of clozapine on psychopathology depends on prefrontal cortical function.

Adolescent↗
PubMed1991

Mortality and morbidity in patients receiving encainide, flecainide, or placebo. The Cardiac Arrhythmia Suppression Trial.

BACKGROUND AND METHODS: In the Cardiac Arrhythmia Suppression Trial, designed to test the hypothesis that suppression of ventricular ectopy after a myocardial infarction reduces the incidence of sudden death, patients in whom ventricular ectopy could be suppressed with encainide, flecainide, or moricizine were randomly assigned to receive either active drug or placebo. The use of encainide and flecainide was discontinued because of excess mortality. We examined the mortality and morbidity after randomization to encainide or flecainide or their respective placebo. RESULTS: Of 1498 patients, 857 were assigned to receive encainide or its placebo (432 to active drug and 425 to placebo) and 641 were assigned to receive flecainide or its placebo (323 to active drug and 318 to placebo). After a mean follow-up of 10 months, 89 patients had died: 59 of arrhythmia (43 receiving drug vs. 16 receiving placebo; P = 0.0004), 22 of nonarrhythmic cardiac causes (17 receiving drug vs. 5 receiving placebo; P = 0.01), and 8 of noncardiac causes (3 receiving drug vs. 5 receiving placebo). Almost all cardiac deaths not due to arrhythmia were attributed to acute myocardial infarction with shock (11 patients receiving drug and 3 receiving placebo) or to chronic congestive heart failure (4 receiving drug and 2 receiving placebo). There were no differences between the patients receiving active drug and those receiving placebo in the incidence of nonlethal disqualifying ventricular tachycardia, proarrhythmia, syncope, need for a permanent pacemaker, congestive heart failure, recurrent myocardial infarction, angina, or need for coronary-artery bypass grafting or angioplasty. CONCLUSIONS: There was an excess of deaths due to arrhythmia and deaths due to shock after acute recurrent myocardial infarction in patients treated with encainide or flecainide. Nonlethal events, however, were equally distributed between the active-drug and placebo groups. The mechanisms underlying the excess mortality during treatment with encainide or flecainide remain unknown.

Actuarial Analysis↗
PubMed1991

Case report 672: Gorham's disease.

A confusing early "benign" appearance which preceded subsequent radiographic progression of a case of massive osteolysis is presented. Proof of Gorham's disease was obtained by open biopsy of the left femur in this 21-year-old woman who presented with an unusual cortical lesion in the femoral shaft. The lesion initially was subtle in its radiological features but progressed considerably over a 2-year period before biopsy was undertaken.

Adult↗
PubMed1991

Randomizing responders. Cardiac Arrhythmia Suppression Trial (CAST) investigators.

Three clinical trial designs for use in testing the effect of long-term drug therapy on an outcome are considered: empiric (randomization to one of several specified and fixed therapies); randomization followed by dose-adjustment of the drug; and dose adjustment followed by randomization of responders. It is shown that the latter, though some information may be lost and bias may be introduced, can be more efficient because of the reduction of noise. These results are illustrated using information gathered by the Cardiac Arrhythmia Pilot Study (CAPS) and Cardiac Arrhythmia Suppression Trial (CAST), the former being a pilot study using the second design, and the latter a large clinical trial adopting the third design. For CAST, the efficiency (represented by ratio of sample sizes) is 0.78 relative to the empiric design, and 0.6 relative to the design incorporating randomization followed by dose adjustment.

Anti-Arrhythmia Agents↗
PubMed1991

Issues in the early termination of the aspirin component of the Physicians' Health Study. Data Monitoring Board of the Physicians' Health Study.

The Physicians' Health Study is a randomized, double-blind, placebo-controlled prevention trial of 22,071 US physicians, using a factorial design to evaluate the role of aspirin in the prevention of cardiovascular mortality and beta carotene in the reduction of cancer incidence. After approximately 5 years of follow-up, the aspirin component was terminated, 3 years ahead of schedule. Several factors were considered in the decision to terminate, including a cardiovascular mortality rate markedly lower than expected in both aspirin and placebo subjects, precluding the evaluation of the primary aspirin hypothesis, and a highly significant (P < .00001) and impressive (44%) reduction in the risk of first myocardial infarction in the aspirin group. Issues in the decision to terminate are described in this report.

Adult↗
PubMed1991

The use of coronal computed tomography in the evaluation of Kienbock's disease.

In a prospective study of 12 consecutive patients with Kienbock's disease, direct coronal CT of the wrist was more sensitive than plain films and plain film tomography in demonstrating structural change including sclerosis, compression and fractures of the lunate. Fractures are more common in Kienbock's disease than previously reported. Earlier detection of fractures by CT, before collapse of the lunate occurs, may allow treatment to prevent the collapse.

Female↗
PubMed1991

Proposed factor structure of the Geriatric Depression Scale.

The Geriatric Depression Scale (GDS) is commonly used to measure depression in the elderly. However, there have been no reports of the underlying structure of the GDS. To this end, the GDS was administered to 326 community-dwelling elderly subjects, and the data were subjected to a factor analysis. A five-factor solution was selected and, after a varimax rotation, the factors that emerged could be described as: (1) sad mood, (2) lack of energy, (3) positive mood, (4) agitation, and (5) social withdrawal. This solution accounted for 42.9% of the variance. Knowledge of the factor structure should aid both clinicians and researchers in the interpretation of responses on the GDS.

Activities of Daily Living↗
PubMed1991

A preliminary study comparing sleep restriction and relaxation treatments for insomnia in older adults.

This study compared Sleep Restriction Therapy (SRT) and Relaxation Therapy (RLT) as treatments for insomnia in a sample of community-residing elderly (mean age, 69.7 years). SRT subjects (n = 10) and RLT subjects (n = 12) reported information about their sleep twice daily to a telephone recording machine for 2 weeks of baseline, 4 weeks of treatment, and 2 weeks at 3-month follow-up. Results showed sleep latency and waking after sleep onset were significantly reduced for both treatment groups under active treatment. Predictable reductions in time in bed and improved sleep efficiency reported during active treatment by SRT subjects were still apparent at 3-month follow-up; no corresponding changes were found for RLT. In both groups, increased total sleep time was reported at follow-up; the improvement for SRT subjects was approximately twice that seen in RLT. These findings, at this early stage in the development of behavioral treatments for insomnia in older adults, encourage further study.

Aged↗
PubMed1991

A reading of Freud's Papers on Technique.

Freud's Papers on Technique (1911-1915) is the canonical description of the psychoanalytic procedure. It is a puzzling work because it is dominated by the original paradigm of treatment as memory-retrieval, while at the same time it introduces a new picture, more consistent with Freud's emerging theory of passions, according to which treatment is the stirring up and integration of wishes. I suggest that Papers on Technique becomes less puzzling if we assume that, when he wrote it, Freud was mainly concerned not with theory but with a crucial problem of practice. In exchange for some theoretical inconsistency Freud acquired an important practical advantage, and Papers on Technique uses that advantage to teach analysts how to divide the patient's consciousness into a passionately committed experience, on the one hand, and a detached contemplation, on the other hand, without worrying about the element of manipulation that is involved. The lesson is that a theoretical ambivalence of this sort is essential to the analytic stance.

Freudian Theory↗