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Biomedical subjects

E S Freedland

Publications and source records attributed to E S Freedland.

8 recordsLinked to original sources
PubMed1999

Lorazepam for the prevention of recurrent seizures related to alcohol.

BACKGROUND AND METHODS: Alcohol abuse is one of the most common causes of seizures in adults. In a randomized, double-blind study, we compared lorazepam with placebo for the prevention of recurrent seizures related to alcohol. Over a 21-month period, we studied consecutive patients with chronic alcohol abuse who were at least 21 years of age and who presented to the emergency departments of two hospitals in Boston after a witnessed, generalized seizure. The patients were randomly assigned to receive either 2 mg of lorazepam in 2 ml of normal saline or 4 ml of normal saline intravenously and then observed for six hours. The primary end point was the occurrence of a second seizure during the observation period. RESULTS: Of the 229 patients who were initially evaluated, 186 met the entry criteria. In the lorazepam group, 3 of 100 patients (3 percent) had a second seizure, as compared with 21 of 86 patients (24 percent) in the placebo group (odds ratio for seizure with the use of placebo, 10.4; 95 percent confidence interval, 3.6 to 30.2; P<0.001). Forty-two percent of the placebo group were admitted to the hospital, as compared with 29 percent of the lorazepam group (odds ratio for admission, 2.1; 95 percent confidence interval, 1.1 to 4.0; P=0.02). Seven patients in the placebo group and one in the lorazepam group were transported to an emergency department in Boston with a second seizure within 48 hours after hospital discharge. CONCLUSIONS: Treatment with intravenous lorazepam is associated with a significant reduction in the risk of recurrent seizures related to alcohol.

Adult↗
PubMed1993

Alcohol and trauma.

Alcohol usage is an integral causal factor in all types of trauma. Additionally, both the acute and to a much greater extent chronic usage of alcohol impair the body's normal physiologic responses to injury. Emergency physicians are painfully aware of the relationship between alcohol and trauma. However, we occasionally fail to appreciate the body's altered response and physical state due to alcohol. We frequently fail to use this opportunity to confront patients with the fact that they have a problem and refer them appropriately to rehabilitation programs.

Abdominal Injuries↗
PubMed1988

Appendicitis: evaluation by Tc-99m leukocyte scan.

Diagnosing appendicitis may be difficult. We report the use of a new technetium-99m-albumin colloid white blood cell (TAC-WBC) scan in the evaluation of appendicitis. In a synthesis requiring 75 minutes, autologous neutrophils and macrophages from 40 mL of whole blood were labelled with technetium-99m-albumin colloid and administered to 100 patients with possible appendicitis. The entire process, from labelling the cells to completion of the scan took a maximum of 5 1/4 hours. Two patients had second scans on separate hospitalizations. Twenty-six patients had appendicitis; 12 had perforations, five of whom had an abscess. Eighty-five scans were read as either positive or negative for appendiceal pathology with a sensitivity of 89%, a specificity of 92%, and an accuracy of 92% in diagnosing appendicitis. Seventeen scans were indeterminant; eight of these patients had appendicitis. The value of the TAC-WBC scan in the evaluation of appendicitis lies in its ability to be used emergently, its high negative predictive value for men and women (NPV = 97%), and its high positive predictive value for men (PPV = 93%). At present, the scan does not appear to be reliable in diagnosing appendicitis in women (PPV = 43%). It is most useful in those patients in whom diagnosis is uncertain, and should not be used in patients with clear-cut appendicitis in whom its use will delay definitive surgical care.

Abscess↗
PubMed1987

An unusual cause of headache: a dentigerous cyst in the maxillary sinus.

We report the case of a patient with a dentigerous cyst in the maxillary sinus presenting as two months of intermittent, unilateral, pressure-like headaches. The diagnosis was suspected after an upright Waters' projection radiogram and confirmed histologically after surgical removal. The patient was symptom free one year later.

Adult↗
PubMedDate not supplied

Alcohol-related seizures, Part I: Pathophysiology, differential diagnosis, and evaluation.

Alcoholism may be society's most devastating problem short of war and malnutrition. Perhaps the most complex and perplexing medical complication of alcoholism is alcohol-related seizures. This article is a collective review designed to provide emergency physicians with an overview of the topic that is pertinent to their clinical practice. Part 1 addresses the pathophysiology, differential diagnosis, and evaluation of alcohol-related seizures. Part 2 will concentrate on the clinical presentation, management, and disposition. In addition, a classification of alcohol-related seizures will be proposed.

Alcoholism↗
PubMedDate not supplied

Alcohol-related seizures, Part II: Clinical presentation and management.

Alcoholism may be society's most devastating problem short of war and malnutrition. Perhaps the most complex and preplexing medical complication of alcoholism is alcohol-related seizures. This article is a collective review designed to provide emergency physicians with an overview of the topic that is pertinent to their clinical practice. Part 1 addressed the pathophysiology, differential diagnosis, and evaluation of alcohol-related seizures. Part 2 focuses on the clinical presentation, management, and disposition. In addition, a classification of alcohol-related seizures is proposed.

Alcoholism↗