PubMed Health⌕ Search

Biomedical subjects

A P Freeman

Publications and source records attributed to A P Freeman.

6 recordsLinked to original sources
PubMed1989

Sustained normalization of cardiac function by chelation therapy in thalassaemia major.

The effect of iron chelation using subcutaneous desferrioxamine on the iron-overloaded heart was studied prospectively over 4 years in 23 asymptomatic patients (mean age 13.2 +/- 5.3 years) with thalassaemia major and transfusion-dependent anaemia. The haemoglobin was maintained greater than 10 g/dl by transfusion and chelation therapy to achieve a negative iron balance. Chelation was closely supervised to ensure compliance. Despite an increase in calculated iron load due to transfusion from 34 +/- 27 g to 63 +/- 28 g, there was a sequential fall in serum ferritin levels from 3148 +/- 1956 ng/ml to 2228 +/- 1825 ng/ml (P less than 0.05). Abnormalities of left ventricular (LV) function, assessed by radionuclide angiography, were present at rest or during exercise in 18 of 23 patients (78%) prior to therapy. Normal LV function was restored in 11 of these 18 patients, five continuing to have abnormal function and two dying. There was a significant increase in resting LVEF from 50 +/- 8% to 57 +/- 6% (P less than 0.01). Peak exercise LVEF rose from 51 +/- 11% to 65 +/- 7% (P less than 0.001). We conclude that the common subclinical abnormalities of LV function induced by iron overload in unchelated patients with thalassaemia major can be reversed with long-term subcutaneous infusions of desferrioxamine.

Adolescent↗
PubMed1985

Regional left ventricular wall motion assessment: comparison of two-dimensional echocardiography and radionuclide angiography with contrast angiography in healed myocardial infarction.

The diagnostic ability of radionuclide angiography (RNA) and 2-dimensional echocardiography (2-D echo) to assess regional left ventricular (LV) wall motion was compared with contrast angiography in 52 patients with healed myocardial infarction. After 5 patients were excluded for inadequate 2-D echocardiographic studies, the LV images of 47 patients obtained by all 3 techniques were divided into 7 segments for analysis. Both 2-D echo and RNA showed close agreement with contrast angiography in assessing normal vs abnormal wall motion in the anterobasal (91%, 91%), anterolateral (87%, 79%) and posterolateral segments (77%, 79%). The sensitivity in detecting wall motion abnormalities was highest for 2-D echo and RNA in the anterolateral (83%, 77%) and apical (95%, 84%) segments and lowest for the inferior segment (48%, 48%). Specificity of 2-D echo and RNA was high, ranging from 94% in the anterolateral segment to 71% in the septal segment for 2-D echo, and from 91% in the inferior segment to 81% in the posterobasal and septal segments for RNA. Major discrepancies with contrast angiography occurred more often in the posterobasal, posterolateral, inferior and septal LV segments. Thus, in comparison with contrast angiography, 2-D echo and RNA are reliable for detecting anterior and apical wall motion abnormalities, but relatively less sensitive for detecting wall motion abnormalities involving the inferior, posterobasal and posterolateral LV segments.

Aged↗
PubMed1985

Late cardiac, thyroid, and pulmonary sequelae of mantle radiotherapy for Hodgkin's disease.

Cardiac, thyroid and pulmonary function were evaluated in 25 patients aged 35 years or under, treated for Hodgkin's disease by mantle radiotherapy 5-16 years previously. No patient had symptoms of heart disease. Although thallium myocardial perfusion scintigraphy was normal in all patients, abnormalities of myocardial function were detected in 6 (24%) patients using gated equilibrium rest and exercise radionuclide ventriculography. Resting left ventricular ejection fraction (LVEF) was abnormal in 1 patient, and in 3 patients there was an abnormal LVEF response to exercise. All 6 patients had right ventricular dilatation. Apical hypokinesia was present in 4 of these patients. A small asymptomatic pericardial effusion was detected by M-Mode echocardiography in only 2 (8%) patients. Twenty-three (92%) patients had evidence of abnormal thyroid function. Two (8%) patients had become clinically hypothyroid. Serum TSH was elevated in 13 (52%) patients and TRH stimulation test was abnormal in a further 10 (40%) patients in whom TSH was normal. Pulmonary function studies showed a moderate decrease in diffusing capacity (72% of predicted) and a minor reduction in lung volume. Although a high incidence of cardiac, thyroid and pulmonary abnormalities was detected, only the 2 patients who had become hypothyroid were symptomatic. Modification of the irradiation technique may reduce the incidence of cardiac abnormalities, but is unlikely to alter significantly the thyroid or pulmonary sequelae.

Adult↗