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Biomedical subjects

Michael Friedman

Publications and source records attributed to Michael Friedman.

At least 37 records · Page 2Linked to original sources
PubMed2005

Guided bone regeneration in the treatment of segmental diaphyseal defects: a comparison between resorbable and non-resorbable membranes.

This study compares non-absorbable, ethyl cellulose (EC) membranes and absorbable, chitosan (CH) membranes in a rabbit model. Bone regeneration, evaluated by radiological and pathological parameters, was seen in both groups. In the EC group the process was faster but was followed by a sharp decrease, whereas in the CH group it was slower and continuous.

Absorbable Implants↗
PubMed2005

Standardized clinical outcome rating scale for depression for use in clinical practice.

The integration of research into clinical practice to conduct effectiveness studies faces multiple obstacles. One obstacle is the burden of completing research measures of outcome. A simple, reliable, and valid measure that could be rated at every visit, incorporated into a clinician's progress note, and reflect the DSM-IV definition of a major depressive episode (including partial and full remission from the episode) would enhance the ability to conduct effectiveness research. The goal of the present study was to examine the reliability and validity of such a measure. Three hundred and three psychiatric outpatients who were being treated for a DSM-IV major depressive episode were rated on the Standardized Clinical Outcome Rating for Depression (SCOR-D), 17-item Hamilton Rating Scale for Depression, Montgomery-Asberg Depression Rating Scale, and the Global Assessment of Functioning. We examined the correlation between the SCOR-D and the other measures, and conducted an analyses of variance to compare mean values on these measures for each rating point on the SCOR-D. The inter-rater reliability of the SCOR-D dimensional ratings and categorical determination of remission were high. The SCOR-D was highly correlated with the other scales, and there were significant differences on the other measures of depression severity between each adjacent rating level of the SCOR-D. The SCOR-D is a brief standardized outcome measure linked to the DSM-IV approach toward defining remission that can be incorporated into routine clinical practice without adding undue burden to the treating clinician with some evidence of reliability and validity. This measure could make it more feasible to conduct effectiveness studies in clinical practice.

Adolescent↗
PubMed2005

Intraoperative intact parathyroid hormone level monitoring as a guide to parathyroid reimplantation after thyroidectomy.

OBJECTIVE: The goal of this study was to determine whether intraoperative intact parathyroid hormone (IOiPTH) levels can predict the functional status of remaining parathyroids at the end of total thyroidectomy and thereby be a guide for parathyroid autotransplantation when glands are deemed not functional. STUDY DESIGN: Prospective study involving 23 patients undergoing either total thyroidectomy or completion thyroidectomy METHODS: During surgery, an attempt was made to identify all four parathyroid glands. Normal size vascular glands were preserved, whereas avascular glands were microdissected and reimplanted. Serial IOiPTH was measured preoperatively after each parathyroid was identified, manipulated, or removed and serum iPTH measurements were done postoperatively up to 56 days. RESULTS: The sensitivity of low IOiPTH in identifying a devascularized gland was 88.9%, and specificity was 92.9%. A normal IOiPTH level indicates at least two functioning glands. IOiPTH levels between 1.5 and 10 pg/mL indicate only one functional gland. Undetectable IOiPTH levels indicate no residual functioning gland. CONCLUSIONS: For patients undergoing total or completion thyroidectomy, IOiPTH should be routinely measured at the end of the procedure, and a level less than 10 pg/mL requires reassessment of remaining parathyroid glands. Vascularized glands should be preserved regardless of IOiPTH levels. Devascularized glands or glands of questionable vascularity should be considered for autotransplantation.

Humans↗
PubMed2005

Aberrant EGFR and chromosome 7 associate with outcome in laryngeal cancer.

OBJECTIVES/HYPOTHESIS: Epidermal growth factor receptor (EGFR) over-expression has been reported as a prognostic indicator in laryngeal cancer; however, the association with disease outcome has been inconsistent among studies. Here, we use fluorescence in situ hybridization (FISH) in addition to immunohistochemistry to assess laryngeal squamous cell carcinoma (SCC) to determine whether FISH can better predict patient outcome. STUDY DESIGN: Retrospective study on 59 patients presenting with advanced disease. METHODS: EGFR and chromosome 7 genomic statuses were measured using FISH, and EGFR expression was assessed by immunohistochemistry on formalin-fixed, paraffin-embedded specimens and correlated with outcome in the 59 patients. RESULTS: EGFR expression was marginally associated with outcome, whereas both EGFR and chromosome 7 FISH status were significantly associated with outcome, and the combination of EGFR and chromosome 7 FISH status provided the strongest association of any two combined parameters (P = .0004). Combining EGFR expression with EGFR and chromosome 7 FISH status provided further improvement (P > .0001). CONCLUSIONS: Measurements of EGFR and chromosome 7 FISH status, and to a lesser extent EGFR expression, have potential value in treatment planning for patients with laryngeal SCC.

Adult↗
PubMed2005

Does severity of obstructive sleep apnea/hypopnea syndrome predict uvulopalatopharyngoplasty outcome?

OBJECTIVES: Uvulopalatopharyngoplasty (UP3) is the single most commonly performed surgical procedure for the treatment of obstructive sleep apnea/hypopnea syndrome (OSAHS), but its success is limited. Our objective was to determine whether severity of disease of OSAHS based on polysomnography (PSG) data (apnea/hypopnea index [AHI]) is a significant factor in predicting successful treatment by UP3. In addition, we compared anatomic staging with severity of disease to determine which is the better predictor of success. STUDY DESIGN: A retrospective chart review of 134 patients who underwent UP3 as an isolated procedure for the treatment of OSAHS in a tertiary university-affiliated medical center. RESULTS: Forty-five patients had mild disease with an AHI less than 20. The surgical success rate (defined as a 50% reduction in AHI and a postoperative AHI of < 20) was 26.7%. There were 40 patients with moderate disease (AHI 20-40) who had a surgical success rate of 42.5%. There were 49 patients with severe disease (AHI < 40) with a surgical success rate of 26.5%. The same patients were analyzed by the Friedman Staging System using anatomic findings without incorporating the severity of disease. Results indicated the following. Stage I had a success rate of 80.6%, stage II patients had a success rate of 37.9%, and stage III had a success rate of 8.1%. Assessment of severity within each stage did not affect outcome. CONCLUSIONS: Patients with mild disease based on PSG data do not have a better chance of successful treatment than patients with severe disease. Severity of disease should not be incorporated in the staging system. The Friedman Staging System based on anatomic factors is superior to severity of disease as a predictor of successful UP3.

Follow-Up Studies↗
PubMed2005

Why isn't bupropion the most frequently prescribed antidepressant?

OBJECTIVE: Reviews of antidepressant medication efficacy suggest that all antidepressants are equally effective. Bupropion is less likely than other antidepressants to cause weight gain and sexual dysfunction, the 2 side effects that are of greatest concern to patients and that have the greatest impact on long-term compliance. If bupropion is as effective as other antidepressants, and it does not cause the side effects that are the most frequent causes of long-term noncompliance, then why isn't it the most frequently prescribed antidepressant medication? To understand psychiatrists' decision making at the time an antidepressant is chosen, we conducted the Rhode Island Factors Associated With Antidepressant Choice Survey (FAACS). METHOD: For 1137 DSM-IV-diagnosed depressed patients initiated on an antidepressant, the treating psychiatrist completed a 43-item questionnaire listing factors that might have influenced the choice of medication. The questionnaire was filled out immediately after the antidepressant was prescribed to treat a depressive disorder. This study was conducted from August 2001 to February 2002. RESULTS: Because the reasons for choosing a medication to augment an existing regimen might be different from those used in monotherapy, augmentation trials were excluded from the analysis, leaving a sample of 965 patients. Bupropion was rarely prescribed when the presence of comorbid anxiety disorders or symptoms reflecting central nervous system activation influenced antidepressant selection. When the desire to avoid side effects, especially sexual dysfunction and weight gain, were the basis of selection, then bupropion was significantly more often prescribed than other antidepressants (p < .001). CONCLUSIONS: Although there is little evidence that patient factors predict differential medication response, psychiatrists are strongly inclined to base antidepressant selection on clinical profiles and avoid prescribing bupropion for depressed patients with high anxiety. Possible reasons for the discrepancy between psychiatrists' prescribing habits and the results of empirical study are discussed.

Adult↗
PubMed2005

Differences between minimally depressed patients who do and do not consider themselves to be in remission.

OBJECTIVE: We recently derived a cutoff on a self-report scale corresponding to the most commonly used definition of remission in depression treatment studies (i.e., Hamilton Rating Scale for Depression [HAM-D] score < or = 7). However, recent research has suggested that use of this cutoff on the HAM-D to define remission is overinclusive. The goal of the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project was to examine how many depressed patients in ongoing treatment who are considered to be in remission by a self-report equivalent of the HAM-D definition of remission nonetheless do not consider themselves to be in remission. METHOD: Five hundred thirty-five psychiatric outpatients treated for a DSM-IV major depressive episode were asked whether they considered themselves to be in remission and completed the Clinically Useful Depression Outcome Scale (CUDOS), a measure of the severity of the DSM-IV symptoms of depression. The study was conducted from August 2003 until July 2004. RESULTS: Nearly one quarter of the patients who met the remission threshold on the CUDOS (55/249) did not consider themselves to be in remission. Among the CUDOS remitters, the total score on the CUDOS was significantly lower (p < .001) in patients who considered themselves to be in remission than in patients who did not indicate that they were in remission. Examination of specific symptoms revealed greater appetite disturbance and hypersomnia in the patients who did not think they were in remission. CONCLUSIONS: Our results suggest that heterogeneity of clinical status exists even among patients who are minimally depressed and considered to be in remission according to contemporary definitions on symptom severity scales.

Adult↗
PubMed2004

Pharmacokinetic and pharmacodynamic aspects of gastroretentive dosage forms.

Controlled release gastroretentive dosage forms (CR-GRDF) enable prolonged and continuous input of the drug to the upper parts of the gastrointestinal (GI) tract and improve the bioavailability of medications that are characterized by a narrow absorption window. CR-GRDF provide a means to utilize all the pharmacokinetic (PK) and pharmacodynamic (PD) advantages of controlled release dosage forms for such drugs. Thus, CR-GRDF may improve therapy with clinically used medications, as well as enable oral administration of drugs, or drug candidates, that hitherto had to be infused parenterally. This manuscript discusses the complexity of the PK and PD factors that influence the treatment benefits of CR-GRDF and summarizes the results of our recent in vivo investigations in animal models (rats and dogs) and in human subjects. We found that a CR-GRDF formulation was superior to the other modes of administration for levodopa and riboflavin, but not for metformin. The PK and PD rationales of GRDFs for the studied drugs are presented and discussed. We conclude that due to the complexity of the PK and PD factors for a certain drug, the rationale for continuous administration obtained by CR-GRDF should be assessed and established in vivo.

Animals↗
PubMed2004

Primary and secondary vulvar vestibulitis syndrome: systemic pain perception and psychophysical characteristics.

OBJECTIVE: Women with primary and secondary vulvar vestibulitis syndrome (VVS) report similar vulvar pain symptoms; however, it is not clear whether these subsets have similar pain and psychophysical characteristics. This study evaluated systemic pain perception, cardiovascular measures, and anxiety level in women with primary and secondary VVS. STUDY DESIGN: Eighty-nine women were enrolled in the study: 44 had primary vulvar vestibulitis, 45 had secondary vulvar vestibulitis. Their anxiety level was first assessed. Then, heat pain stimuli were applied to the forearm, and pain threshold and pain scores for suprathreshold phasic (44 degrees C-48 degrees C) and tonic (46 degrees C) stimuli were assessed by visual analog scale. Finally, blood pressure was recorded using a volume clamp method before, during, and after a tonic stimulus of 1 minute at 46 degrees C. RESULTS: Women with primary vulvar vestibulitis had higher visual analog scale scores for pain perception at 46 degrees C to 48 degrees C, a higher level of trait anxiety 43.3 +/- 1.5 versus 37.8 +/- 1.5 (P=.010), an increased incidence of dysmenorrhea (chi(2) 8.9, P=.003), and lower resting blood pressure: systolic (108.6 +/- 2.1 vs 118.9 +/- 2.0 mm Hg) (P>.001) and diastolic (59.3 +/- 1.6 vs 64.2 +/- 1.5 mm Hg) (P=.038). Logistic regression revealed that dysmenorrhea and lower systolic blood pressure are associated with primary VVS. CONCLUSION: Women with primary and secondary VVS differ in their systemic pain perception and psychophysical characteristics. The impact of these findings on treatment modalities should be further evaluated.

Adult↗
PubMed2004

Association between quantitative sensory testing, treatment choice, and subsequent pain reduction in vulvar vestibulitis syndrome.

UNLABELLED: The chronic pain syndrome of vulvar vestibulitis is a major cause of sexual dysfunction, and complete cure is not always achieved. The aim of the study was to determine whether the psychophysical characteristics of systemic pain perception predict treatment choice and outcome. Ninety women with vulvar vestibulitis syndrome were evaluated by using quantitative sensory testing with heat pain threshold measurements and pain scores for suprathreshold stimuli applied to the forearm, blood pressure measurements, and an assessment of the number of other pain disorders. Women were free to choose a surgical procedure (ie, vestibulectomy), one of the possible nonsurgical treatments (eg, biofeedback, cognitive-behavioral therapy, or hypoallergic agents), or to avoid treatment entirely. Eight months later, women reported the success of the treatment on the basis of reduction in the level of vulvar pain. Vestibulectomy demonstrated the best therapeutic effectiveness (chi2, 26.4; P <.0001). Women who chose this type of treatment had lower pain scores (P =.038) and fewer pain syndromes other than the vulvar pain (P =.025). Logistic regression analysis, controlling for the effect of vestibulectomy, indicated that lower experimental pain scores (P =.044), fewer pain disorders (P =.023), and higher systolic blood pressure (P =.039) are predictive variables for reduction of vulvar pain. An assessment of systemic pain perception might be helpful in choosing the optimal treatment and in predicting its success. PERSPECTIVE: The present study suggests that pain perception variables might be of value in the prediction of treatment choice and outcome among women with vulvar vestibulitis.

Adolescent↗
PubMed2004

Z-palatoplasty (ZPP): a technique for patients without tonsils.

OBJECTIVE: Patients without tonsils and with Friedman tongue position (FTP) III and IV are poor candidates for uvulopalatopharyngoplasty (UP3). Even when combined with adjunctive hyopharyngeal techniques, results are poor. We assessed a modified uvulopalatoplasty based on a bilateral Z-plasty in treating patients without tonsils who have obstructive sleep apnea/hypopnea syndrome (OSAHS). METHODS: 25 patients treated with a modified technique were matched with 25 patients previously treated with classic UP3. All patients in both groups also had radiofrequency tongue base reduction. Preoperative vs. postoperative measures of objective treatment success and subjective symptoms were compared for the 2 groups. Morbidity, including pain levels, narcotic use, and return to solid diet and normal activity, as well as complications were studied. RESULTS: Subjective improvement was good for both groups, but objective clinical improvement was significantly better for the experimental group. Morbidity and complications for the experimental group were comparable to the control group and to other published series on UP3. CONCLUSIONS: A modified technique for patients without tonsils who have OSAHS is presented. The new technique is more successful with acceptable morbidity for patients with OSAHS than classical techniques.

Adult↗
PubMed2004

A simplified technique for airway correction at the nasal valve area.

OBJECTIVE: To describe a simplified system to correct an obstructed nasal airway utilizing the Mitek bone anchor suspension technique (BAST). STUDY DESIGN: This is a retrospective/prospective study of patients with nasal airway obstruction treated with the BAST. The retrospective study is based on 188 patients who underwent the BAST over the past 5 years and were analyzed to assess complications and subjective results. The prospective group consisted of 52 patients with unilateral or bilateral valve obstruction who were assessed with preoperative and postoperative rhinomanometry and quality of life (QOL) questionnaires. METHODS: The surgical technique is based on introducing a bone anchor into the orbital rim through a 4-mm stab incision. The bone anchor system comes with attached sutures that are easily passed to the valve area and secured in position to support and open the valve area. Preoperative and postoperative QOL surveys and rhinometric studies were compared in 52 patients to assess the subjective and objective outcomes of the procedure. RESULTS: Based on subjective data, over 90% of the patients had significant improvement in their nasal airway. Objectively, cross-sectional areas at the nasal valve were found to have significantly improved postoperatively (P < 0.046). Complications were rare and limited to localized infection, reaction to sutures, and loss of support. CONCLUSION: Correction of nasal valve obstruction with this technique provides a simplified alternative in selected patients to improve airflow and decrease nasal resistance. The BAST allows for a simple, highly effective correction of an obstructed airway with minimal complications.

Airway Resistance↗
PubMed2004

Vulvar vestibulitis severity--assessment by sensory and pain testing modalities.

Vulvar vestibulitis syndrome (VVS) is a common cause of dyspareunia in pre-menopausal women. Previous quantitative sensory test (QST) studies have demonstrated reduced vestibular pain thresholds in these patients. Here we try to find whether QST findings correlate to disease severity. Thirty-five vestibulitis patients, 17 with moderate and 18 with severe disorder, were compared to 22 age matched control women. Tactile and pain thresholds for mechanical pressure and thermal pain were measured at the posterior fourcette. Magnitude estimation of supra-threshold painful stimuli were obtained for mechanical and thermal stimuli, the latter were of tonic and phasic types. Pain thresholds were lower and supra-threshold magnitude estimations were higher in VVS patients, in agreement with disease severity. Cut-off points were defined for results of each test, discriminating between moderate VVS, severe VVS and healthy controls, and allowing calculation of sensitivity and specificity of the various tests. Our findings show that the best discriminative test was mechanical pain threshold obtained by a simple custom made 'spring pressure device'. This test had the highest kappa value (0.82), predicting correctly 88% of all VVS cases and 100% of the severe VVS cases. Supra-threshold pain magnitude estimation for tonic heat stimulation also had a high kappa value (0.73) predicting correctly 82% overall with a 100% correct diagnosis of the control group. QST techniques, both threshold and supra-threshold measurements, seem to be capable of discriminating level of severity of this clinical pain syndrome.

Adult↗
PubMed2004

Uvulopalatoplasty (UP2): a modified technique for selected patients.

OBJECTIVES: The goal of uvulopalatopharyngoplasty (UP3) in the treatment of obstructive sleep apnea-hypopnea syndrome (OSAHS) is to reduce obstruction by eliminating redundant tissue in three areas: the soft palate, tonsils, and pharynx. However, some OSAHS patients may present with tonsil hypertrophy and elongated soft palate without redundant pharyngeal folds. We treated this group of patients with tonsil reduction using radiofrequency coblation combined with uvulopalatoplasty (UP2) using a palatal flap technique without pharyngoplasty. Morbidity and outcome was then compared with a group of patients who underwent classic UP3. STUDY DESIGN: A retrospective, nonrandomized study comparing morbidity and outcomes of the modified technique (UP2) with patients who underwent standard UP3. METHODS: Patients were all staged according to the previously described Friedman staging system. Those with redundant pharyngeal folds were treated with UP3 (n = 33), and those without redundant pharyngeal folds were treated with tonsil coblation and UP2 (n = 30). Charts of patients undergoing UP2 and UP3 between July 1, 2001 and July 1, 2002 were reviewed. Thirty-three consecutive patients who underwent UP3 were selected for study as well as 30 consecutive patients who underwent UP2. Pre- and postoperative quality of life questionnaires and patient questionnaires focusing on diet, pain, and return to activity were reviewed to assess subjective morbidity and elimination of symptoms. Objective measurements include preoperative and postoperative (6-18 months) polysomnography (PSG). RESULTS: Symptom elimination and objective PSG results were compared. There was no statistical difference in results between the UP3 group and the UP2 group. Morbidity, however, was significantly more prominent, and recovery was more prolonged, in the UP3 group. Patients undergoing UP2 had fewer pain days, less narcotic use, quicker return to solid diet, and less long-term complaints of globus sensation. CONCLUSIONS: UP2 with tonsil coblation offers some reduction in postoperative morbidity without affecting outcome for selected patients with OSAHS. Pain levels, however, are still very significant.

Chi-Square Distribution↗
PubMed2004

Staging of obstructive sleep apnea/hypopnea syndrome: a guide to appropriate treatment.

OBJECTIVE: Early studies by Friedman et al. have demonstrated the value of staging obstructive sleep apnea/hypopnea syndrome (OSAHS) patients for the prediction of success for uvulopalatopharyngoplasty (UPPP) on the basis of short-term follow up. The goal of this study is to test the value of this staging system in a prospective study. STUDY DESIGN: This is a prospective study of two cohorts of patients: one was treated with the benefit of a clinical staging system and the other without. METHODS: Patients with symptoms of OSAHS were assessed by polysomnography and were staged according to a previously described staging system. The staging system is based on palate position, tonsil size, and body mass index (BMI). The control group was treated without the benefit of staging. All patients in the control group were treated with UPPP only. Patients in the experimental group were treated based on their clinical stage. Patients with stage I disease, regardless of the severity of disease, were treated with UPPP only. Selected patients with stage II and stage III disease were treated with UPPP in addition to a staged tongue-base reduction using a radiofrequency technique (TBRF). RESULTS: Follow-up at 6 months showed significant improvement compared with a group of patients treated without the benefit of a staging system. Successful treatment of patients with stage II disease improved from 37.9% to 74.0%. The overall success rate improved from 40% to 59.1%. CONCLUSION: Clearly, patients with stage I disease had the best success rate, but a selective protocol based on clinical staging improves the overall success rate. In addition, it can eliminate as surgical candidates those patients with whom the procedure is likely to fail.

Adult↗
PubMed2004

The vaginal vestibule.

OBJECTIVES: Vulvar vestibule is a common term in the medical nomenclature. In our view, this term is inaccurate. MATERIALS AND METHODS: Herein, we provide evidence from embryologic, anatomic, and architectonic textbooks that shows the links between the vestibule and vagina. RESULTS: Our research proves that the term vulvar vestibule does injustice to the area it describes. CONCLUSIONS: The correct term for vulvar vestibule actually is vaginal vestibule.

Journal Article↗
PubMed2004

Which factors influence psychiatrists' selection of antidepressants?

OBJECTIVE: There is little empirical evidence to guide clinicians in choosing among the diverse array of antidepressants available. In the absence of replicated empirical research guiding the selection of antidepressants, it is of interest to examine what factors psychiatrists consider when prescribing antidepressants. METHOD: For 1,137 depressed patients who received a new antidepressant prescription, the treating psychiatrist completed a 43-item questionnaire listing factors that might have influenced the choice of antidepressant medication. The questionnaire was filled out immediately after an antidepressant was prescribed to treat a depressive disorder. RESULTS: The most common factors influencing antidepressant selection were the avoidance of specific side effects, the presence of comorbid psychiatric disorders, and the presence of specific clinical symptoms. Prior treatment history, including prior positive or failed response to a drug, was the next most frequently endorsed factor influencing medication choice. Some factors that have been commonly discussed in the literature, such as concern about discontinuation syndrome and drug-drug interactions, rarely influenced antidepressant selection. CONCLUSIONS: Because relatively little research has examined clinical features associated with differential response to the newer generation of antidepressants, a study of psychiatrists' prescribing practices highlights priorities for future controlled research. Our results suggest that two priority areas are the treatment of depression with coexisting anxiety symptoms/anxiety disorders and the influence of particular symptoms on response to different medications.

Antidepressive Agents↗