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Biomedical subjects

R J Friedman

Publications and source records attributed to R J Friedman.

At least 19 recordsLinked to original sources
PubMed1992

Influence of gender on survival in patients with stage I malignant melanoma.

BACKGROUND: Women with stage I malignant melanoma (MM) have a survival advantage over men as judged by univariate analysis. However, on multivariate analysis, gender was found to be an independent predictor of survival in only 8 of 14 published studies. OBJECTIVE: This study attempts to explain the disparate findings for gender as a prognostic factor in different multivariate analyses. METHODS: Univariate and multivariate analyses were performed on 832 patients with stage I MM in the New York University Melanoma Cooperative Group (NYU-MCG) data base. The results were compared with those of 14 similar studies. RESULTS: In the NYU-MCG data base, gender, age of the patient, and number of mitoses per square millimeter were not independent factors on multivariate analysis, whereas thickness, anatomic site, and presence of ulceration were. The statistically significant difference in survival by gender on univariate analysis, in the NYU-MCG data base, could be explained by the differences in thickness and anatomic site of the MMs in the sexes. Comparison of these results with the reviewed reports from the literature consistently shows thickness and ulceration to be independent prognosticators of survival. Likewise, most authors agree that age is not an independent predictor. However, there is no consensus with respect to gender and site, each of which was found to be an independent predictor of survival in only about half the studies reviewed. CONCLUSION: The disparate findings for gender in different multivariate analyses are explained by a gender-related difference in anatomic distribution of MM. Gender and site appear to have a similar influence in multivariate analysis and thus either one or the other is a dominant factor in different multivariate analyses.

Adult↗
PubMed1992

Blood conservation in spinal surgery. Review of current techniques.

The potential dangers of homologous blood transfusions are well known. Among the more serious complications of such therapy are hepatitis and acquired immune deficiency syndrome. As a result, blood conservation has become a topic of great interest to both physicians and patients. Numerous studies exist documenting the effectiveness of preoperative autologous blood donation, intraoperative autologous transfusion, hypotensive anesthesia, and postoperative blood salvage. Perioperative recombinant human erythropoietin is a promising new adjunct to these techniques. Careful surgical technique is crucial to the success of these complex modalities. In the absence of tumor, systemic infection, or gross wound contamination, these modalities should be considered when a spinal procedure is planned in which homologous blood may be required.

Animals↗
PubMed1992

Hip arthroplasty in patients with sickle-cell haemoglobinopathy.

We reviewed retrospectively 25 hip arthroplasties in 25 patients with sickle-cell haemoglobinopathy and osteonecrosis. The mean age of the ten women and 15 men at the onset of hip symptoms was 25 years, and at surgery 30 years (16 to 45); 66% had either SS or S-thal disease, 20% sickle-cell trait, and the remainder SC disease. The mean follow-up was 8.6 years (two to 18). Fourteen (40%) of the arthroplasties had been revised at a mean of 7.5 years after the primary procedure and nine other hips were either radiographically and/or symptomatically loose. The overall complication rate was 49% and the infection rate 20%. The risk-to-benefit ratio of hip arthroplasty in sickle-cell haemoglobinopathy is high.

Adolescent↗
PubMed1992

The use of computerized tomography in the measurement of glenoid version.

Computerized tomography was done preoperatively on twenty shoulders (thirteen patients) in which there were severe arthritic changes, to measure glenoid version. Ten of the twenty shoulders had osteoarthrosis; eight, rheumatoid arthritis; and two, gouty arthritis. To help determine normal values, computerized tomographic scans of the chest of sixty-three patients who did not have roentgenographic evidence of disease of the shoulder were studied retrospectively for comparison as a control group. In the group of patients who had severe arthritis, the mean glenoid orientation was 11 degrees of retroversion (range, 2 degrees of anteversion to 32 degrees of retroversion). The computerized tomographic scans showed uneven wear of the glenoid surface, osteophytes, large cysts, and posterior displacement of the humeral head. In the control group, the mean orientation of the glenoid was 2 degrees of anteversion (range, 14 degrees of anteversion to 12 degrees of retroversion). The difference between the groups was significant (p less than 0.0001). Glenoid retroversion was increased in the patients who had severe arthritis, and the computerized tomographic scans accurately revealed the extent and pattern of erosion of the bone.

Adult↗
PubMed1991

The histopathology of dysplastic nevi. Continued controversy.

The histopathologic criteria used in the diagnosis of dysplastic nevi have been a source of controversy, as has the clinical significance of these lesions. Several dermatopathologists noted for their work on dysplastic nevi were asked to contribute responses to questions regarding the architectural and cytological criteria used to classify a melanocytic nevus as dysplastic, the terminology used to describe these lesions, and the role of dysplastic nevi as precursors of melanoma. Although no consensus has been reached regarding the cytologic features required for diagnosis of dysplastic nevi, there is substantial agreement regarding the architectural features of these lesions.

Diagnosis, Differential↗
PubMed1991

Prospective follow-up for malignant melanoma in patients with atypical-mole (dysplastic-nevus) syndrome.

A total of 357 white patients who had melanocytic nevi that fulfilled the clinical criteria for the "classic" atypical-mole (dysplastic-nevus) syndrome (100 or more melanocytic nevi; one or more melanocytic nevi 8 mm or larger in diameter; and, one or more melanocytic nevi with atypical features) were followed for the development of cutaneous malignant melanomas. Seventeen patients (4.8%) developed malignant melanomas during an average follow-up period of 49 months. One patient developed two malignant melanomas. Eight of the malignant melanomas detected were in situ and ten were invasive melanomas (less than 0.86 mm in Breslow thickness), implying an excellent prognosis. The number of malignant melanomas detected in these patients exceeded significantly the number expected to occur in age- and sex-matched white controls. All groups were shown to have an increased risk for the development of malignant melanomas. Total-body photographs were helpful in detecting changes in size, shape, and color that led to the diagnosis of malignant melanoma. These data support the concept that patients with this readily regionalized clinical presentation of classic atypical-mole syndrome are at an increased risk for malignant melanomas and, therefore, should be examined regularly.

Adult↗
PubMed1991

Alterations in the supraspinatus tendon at MR imaging: correlation with histopathologic findings in cadavers.

To determine the histopathologic correlates of alterations in the rotator cuff at magnetic resonance (MR) imaging, 13 cadaveric shoulders (in subjects aged 26-83 years at the time of death) underwent MR imaging in the coronal oblique plane at 1.5 T with proton-density- and T2-weighted spin-echo sequences. Areas corresponding to sites of MR imaging alterations were then examined histologically. Increased signal intensity on proton-density-weighted images (without further increased signal intensity on T2-weighted images) and an indistinct margin at the articular side of the supraspinatus tendon corresponded to eosinophilic, fibrillar, and mucoid degeneration and scarring. Areas of increased signal intensity on T2-weighted images were associated with severe degeneration and disruption of the supraspinatus tendon. Although other authors have suggested that certain MR findings are indicative of tendinitis, the histologic data in this study were not those of active inflammation but rather tendon degeneration.

Adult↗
PubMed1991

Alexia without agraphia associated with spleniogeniculate infarction.

Pure alexia, following an infarction in the distribution of the left posterior cerebral artery, is attributed to damage of the left occipital lobe and the splenium of the corpus callosum. We describe a case of pure alexia in a 57-year-old woman with infarction of the left lateral geniculate body and the splenium of the corpus callosum, a variation on this classic disconnection syndrome.

Cerebral Infarction↗
PubMed1991

Prevention of thromboembolic disease following total knee arthroplasty. Epidural versus general anesthesia.

Seventy-two patients were randomized into a prospective clinical trial to evaluate the effects of epidural (EA) versus general anesthesia (GA) on the incidence of thromboembolic disease (TED) following total knee arthroplasty (TKA). Males received aspirin 650 mg po bid and females low-dose warfarin daily to maintain the prothrombin time at 15 to 16 seconds for pharmacologic prophylaxis against TED. Thirty-four patients had EA and 38 GA for their primary TKA. Contrast venography and ventilation-perfusion scanning were performed on the sixth, seventh, and eighth postoperative days, and these were interpreted in a blinded fashion. The mean age of the 45 males and 27 females was 64 years (range, 42-84 years). There were no significant differences between the two groups with respect to hematocrit, operative time, blood loss, number of units transfused, or hospital stay. Twelve of the 34 patients (35%) receiving an EA and 10 of the 38 patients (26%) receiving GA developed TED, an overall incidence of 31% (p greater than 0.05) Fifty-three percent of the clots were located in the popliteal vein above the trifurcation or more proximal. However, the incidence of proximal vein thrombosis was significantly less in patients receiving an EA (46%) rather than a GA (64%). The incidence and distribution of clots was not affected by the type of pharmacologic prophylaxis, gender, or use of methylmethacrylate. Ten percent of the patients had a positive scan by strict criteria and were thought to have a pulmonary embolism (PE). In patients with a femoral vein clot, the incidence of PE was 67%. One bleeding complication occurred in a patient who took double the appropriate warfarin dose.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Blood loss in total knee arthroplasty.

Over a two-year period, 112 consecutive primary total knee arthroplasties (TKA) were performed according to a standard protocol and were evaluated to determine the effects of intraoperative tourniquet deflation, suction drainage, and immediate continuous passive motion (CPM) on blood loss and the need for blood transfusions. It has been reported that these measures lead to increased morbidity following TKA. The tourniquet was deflated before closure, hemostasis was obtained, and two suction drains were placed for 24 to 48 hours. CPM was started immediately, and continued for a mean of seven days. Serial hematocrits (Hct) were obtained. Mean age of the 64 males and 48 females was 65 years. The diagnosis was osteoarthritis in 86% and rheumatoid arthritis in 14%. Seventy-three percent of the prostheses were cemented and 27% were uncemented. The mean tourniquet time was 104 minutes and the mean length of surgery was 140 minutes. Blood loss measured at surgery averaged 222 ml. Total calculated blood loss averaged 794 ml, but was higher for patients with a cemented versus uncemented prosthesis (p less than .05), and males versus females (p less than .005). It was not related to diagnosis, tourniquet time, or length of surgery. Of the 38% of patients requiring a transfusion (mean, 2.2 units), there was not a significantly greater drop in Hct (from 36.6 to 26.5; change, 10.1) when compared to patients not receiving a transfusion (from 43.1 to 32.5; change, 10.6). Therefore, the need for transfusion was related to preoperative Hct and not the intraoperative or postoperative blood loss.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Factors influencing survival in melanoma.

Multiple factors appear to influence survival of patients with MM. As computer and mathematic analysis techniques advance, the specific effects of these variables, in terms of their impact on survival rates, will be delineated better.

Humans↗
PubMed1991

Volume of malignant melanoma is superior to thickness as a prognostic indicator. Preliminary observation.

There are many clinical and histologic factors that are known to be valuable in predicting survival rates for patients with cutaneous malignant melanomas. Breslow thickness is considered to be the most reliable prognostic factor; however, thickness is a unidimensional measurement. A more accurate mensuration to predict biologic behavior might be one that takes into account the three-dimensional volume of the neoplasm. In a study of 35 primary malignant melanomas, the volumes of the dermal components of the tumors were calculated. Those patients with tumor volumes of 200 mm3 or less had a 91.4% 5-year disease-free survival rate, compared with survival rate of only 16.7% for those patients whose lesions had tumor volumes exceeding 200 mm3. On multivariate analysis, tumor volume exceeded thickness as a prognostic indicator. Thus, measurement of tumor volume proved to be of greater significance than thickness in predicting the outcome for patients with malignant melanomas.

Humans↗
PubMed1991

Distinguishing benign and malignant melanocytic lesions with the AgNOR method.

A silver staining technique has recently been devised to aid in the differentiation between benign and malignant melanocytic lesions. This study showed a statistically significant difference between the staining of silver-nucleolar organizer regions (AgNORs) in melanocytic nevi and that of AgNORs in malignant melanomas.

Diagnosis, Differential↗
PubMed1991

Computer applications in the diagnosis and prognosis of malignant melanoma.

Recent advances in computer technology have begun to make computers a more effective tool in the diagnosis and evaluation of malignant melanoma. Preliminary computer-aided diagnosis programs have been developed. Histologic evaluation applications in both diagnosis and prognosis are also evolving. Further advances in computers may make them an integral part of the diagnosis and prognosis of melanoma in the future.

Computer Simulation↗
PubMed1990

Clinical characteristics of malignant melanomas developing in persons with dysplastic nevi.

A total of 452 patients with dysplastic nevi (DN) were followed prospectively by repetitive, complete cutaneous examinations in order to determine the clinical features of early malignant melanomas (MM) arising in them. Sixteen patients (3.5%) developed 18 newly diagnosed MM during an average follow-up period of 27 months. Twelve of the 18 MM were in situ and all of the primary invasive MM diagnosed prospectively in this follow-up were less than 0.89 mm in Breslow thickness, implying an excellent prognosis. The principal clinical clue to the diagnosis of MM was change in a preexisting pigmented lesion. Total-body photographs were very useful in helping to identify the early MM in these patients.

Adolescent↗
PubMed1990

The role of arthroscopy in the problem total knee replacement.

Fourteen patients were retrospectively reviewed to examine the role of arthroscopy in the diagnosis and treatment of the problem total knee arthroplasty (TKA), and to define parameters for indications, techniques, and results. All patients had undergone a previous TKA, and postoperatively had problems with pain and/or range of motion. Routine evaluation failed to reveal sepsis or aseptic loosening. Arthroscopy was used to evaluate and treat certain specific conditions. The arthroscope was successful in removing loose bodies, correcting patella subluxation with an arthroscopic lateral release, excising a symptomatic pseudomeniscus, and releasing intraarticular adhesions to improve motion and relieve pain. The postoperative knee score improved 73%. Arthroscopy is a valuable tool to evaluate a painful TKA, and can be used to treat certain conditions that would otherwise require an arthrotomy. The rehabilitation time is easier on the patient and much quicker. Arthroscopy of a TKA does not compromise any future procedures. However, it remains a technically demanding procedure whose indications and expectations are still being defined.

Aged↗