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Biomedical subjects

H Freeman

Publications and source records attributed to H Freeman.

At least 19 recordsLinked to original sources
PubMed2000

External beam irradiation as an adjunctive treatment in failing dialysis shunts.

PURPOSE: To evaluate the utility of low-dose irradiation as adjunctive treatment for failing dialysis shunts related to stenoses. MATERIALS AND METHODS: Thirty-one patients with 41 lesions in their dialysis shunts were successfully enrolled for this study. After imaging of the shunt and calculation of venous stenoses, each patient was randomized into one of two segments of the protocol: (i) angioplasty and/or stent placement alone, and (ii) angioplasty and/or stent placement followed by external beam irradiation. All patients with significant venous stenoses (> or =50%) were treated with appropriately sized PTA (percutaneous transluminal angioplasty) and Wallstents. Patients randomized to the external irradiation segment underwent localized irradiation via a Theratron cobalt unit of 7 Gy 0-24 hours and 24-48 hours after intervention. Those patients randomized to the control group received no additional treatment. Clinical follow-up included resumption of successful dialysis with appropriate hemodynamic parameters. Two follow-up shunt images were obtained, follow-up 1 (fu-1) from 90 to 179 days and follow-up 2 (fu-2) from 180 to 365 days. Percentages of significant recurrent stenoses, defined as greater than 50%, were recorded and re-treated as needed. RESULTS: Sixteen of the 31 patients underwent external beam irradiation. There were 21 lesions in the test group that underwent irradiation after intervention, and 20 lesions were treated with intervention alone. There were seven native arteriovenous fistulas and 24 Gore-tex grafts. All stenoses were either venous outflow stenoses (68%) or central stenoses (32%). The authors utilized chi2 analysis to compare restenoses rates between the control and irradiated groups at fu-1 (P<.99) and fu-2 (P<.10). CONCLUSIONS: Although the results show that external beam irradiation has minimal effects on the restenoses of dialysis grafts when used in conjunction with PTA and stent placement, further studies with a larger, more homogenous population are needed to assess the trend of improving patency rates after external beam irradiation.

Adult↗
PubMed1999

Psychiatry in the National Health Service 1948-1998.

BACKGROUND: The 50th anniversary of the inauguration of the NHS provided the occasion to review the evolution of mental health services and of psychiatry itself in Britain during that period. AIMS: The principal themes to be followed were the decline of a mental hospital system that had existed for over a century, the development of an alternative policy of 'community care', the emergence of a numerous and well-trained psychiatric profession, and the interaction between political and legal processes and mental health care. METHOD: An examination of Ministry of Health and Department of Health and Social Security files in the Public Record Office, interviews with influential figures, examination of the secondary literature, and personal experience of events described. RESULTS: The material has been analysed, in the light of the expressed aims, and important trends have been described. The current situation is assessed. CONCLUSIONS: The replacement of one system of care and treatment in Britain by another has been a process fraught with overwhelming difficulties. While adhering to the aim of 'community care', governments have been reluctant to provide the means for achieving this. The psychiatric profession is now faced with very large but ill-defined responsibilities.

Government↗
PubMed1998

Management of extremely low birth weight infants: perceptions of viability and parental counseling practices.

OBJECTIVE: To determine physician opinions, parental counseling, and medical practices for extremely low birth weight (LBW) infants. METHODS: A retrospective survey was sent in August 1996 to 450 California physicians practicing obstetrics. RESULTS: There was a 41% response rate. The mean thresholds for antenatal steroid administration, cesarean delivery for fetal distress and delivery room resuscitation were gestational age between 23 and 24 weeks and weight close to 500 g. Most obstetricians counsel parents regarding survival, resuscitation, and possible death in the delivery room before delivery of an extremely LBW infant. Just over 60% of obstetricians believe that parents have a role in deciding not to resuscitate an infant born at 22 weeks' gestation, this decreases to less than 50% at 24 weeks, and decreases further to less than 30% by 26 weeks' gestation. Just over 40% of obstetricians report their counseling is affected by pediatric opinion, 33% by previous maternal perinatal losses, and less than 20% by maternal drug use or lack of prenatal care, and young maternal age. Language barriers, parental education level, and family insurance affect treatment options in less than 10% of obstetricians. CONCLUSION: Obstetric opinions about delivery room resuscitation of extremely LBW infants are influenced by birth weight and gestational age thresholds, infant, and parental factors. There is a limited willingness by physicians to allow a parental role in decision making in the delivery room for extremely LBW infants.

Adult↗
PubMed1998

A revised measure of symptom-specific health care use.

The objective was to determine physicians' ratings of the clinical importance of common adult symptoms and to use these ratings to develop a new measure of symptom-specific use of health care services. We developed a list of common symptoms using the National Ambulatory Medical Care survey. We surveyed a random sample of internists, family physicians, general practitioners and emergency medicine physicians from the American Medical Association's Physician Masterfile and asked them to rate symptoms' seriousness, impact on quality of life and urgency of need for medical attention. The symptoms' prevalences were determined in a general population survey (National Access to Care Survey). Eleven items were classified as "serious" (median seriousness ratings of 7 or higher on scale from 1 to 10); most of these also were judged to have high impact on quality of life. Another 12 items that were not judged "serious" had median quality of life impact scores of 7 or higher and were classified as "morbid". Sixteen items did not meet criteria for either "serious" or "morbid" symptoms and were classified as "intermediate". Six other items had median seriousness and quality of life impact scores of 3 or less and were classified as "benign". A total of 24 of these items (7 "serious", 8 "morbid", 8 "intermediate" and 1 "benign") were selected to form the symptom-response measure. In the national survey, 26.3% reported one or more serious symptom, 30.6% reported one or more morbid symptom and 29.6% reported one or more intermediate symptom. This new instrument expands on earlier "symptom-response" measures by including a larger number and a broader spectrum of symptoms. This measure should be useful to assess differences in patterns of health care use for particularly serious or morbid conditions; such variations may indicate problems with access to medical care.

Adult↗
PubMed1997

Early onset of action of amineptine.

A priority in the treatment of depression is to obtain rapid improvement at an early stage. Since depressed patients, who are often convinced that nothing can be done for them, may well have difficulty in adhering to the therapeutic management plan, they can be both uncooperative and neglectful of treatment measures. The rapid correction of this often resigned apathy is an essential aspect of treatment. According to a variety of clinical criteria, amineptine often achieves rapid improvement, particularly on measures of psychomotor retardation. Initially, antidepressant medication is an essential measure in the relief of depressive symptoms, although subsequently, it may also become a complement to psychotherapeutic support. Amineptine has been shown to act directly on the dopaminergic pathway, unlike other antidepressants, which act on this system only via their effects on the serotonergic or noradrenergic systems.

Antidepressive Agents, Tricyclic↗
PubMed1997

Cortical and hippocampal volume deficits in temporal lobe epilepsy.

PURPOSE: To use quantitative magnetic resonance imaging (MRI) methods to examine the extent of volume abnormalities in the hippocampus and in extrahippocampal brain regions in localization-related epilepsy of temporal lobe origin (TLE). METHODS: Hippocampal, temporal lobe, and extratemporal lobe volumes were examined with 3-mm spin-echo coronal MRI scans in patients with unilateral TLE who were candidates for temporal lobe resection. Measures were adjusted for normal variation due to intracranial volume and age based on 72 healthy male controls. Group differences between 14 male TLE [7 left TLE (LTLE), 7 right TLE (RTLE)] patients and a subset of 49 age range-matched controls were examined with analysis of variance (ANOVA). RESULTS: As compared with controls, patients with TLE had smaller temporal lobe and frontoparietal region gray matter volumes, bilaterally, smaller temporal lobe white matter volumes bilaterally, and larger ventricular volumes. In contrast to these bilateral tissue volume deficits, hippocampal volume deficits in TLE were ipsilateral to the epileptogenic temporal lobe. CONCLUSIONS: Extrahippocampal volume abnormalities were bilateral and occurred in both temporal and extra-temporal cortical regions in TLE, whereas hippocampal deficits were related to the side of the epileptogenic focus. These data suggest that brain abnormalities in TLE are not limited to the epileptogenic region.

Adolescent↗
PubMed1997

Prospective evaluation of neutrophil autoantibodies in 500 consecutive patients with inflammatory bowel disease.

Previous studies have shown antineutrophil cytoplasmic autoantibodies (ANCA) in patients with inflammatory bowel disease (IBD). A particular subclass, the so-called 'atypical' (perinuclear) p-ANCA type, occurs in the majority of patients with ulcerative colitis. The purpose of this prospective study was to assess, in a blinded fashion, this 'subclinical' serological marker in a consecutive series of IBD patients. Five hundred patients were evaluated, including 247 patients with ulcerative colitis and 253 with Crohn's disease involving the small and/or large intestine. Overall, 194 (38.8%) of all patients with IBD were positive, including 164 (66.3%) with ulcerative colitis and 30 (11.9%) with Crohn's disease. Except for coexistent sclerosing cholangitis, no other clinical or laboratory variable had an effect on the rate of ANCA detection. This is the largest single study of ANCA in patients with IBD and the only study to provide data solely from a single Canadian centre. Results emphasize the immunopathological differences between ulcerative colitis and Crohn's disease, and indicate that both disorders are heterogeneous inflammatory disease processes.

Adult↗
PubMed1997

The costs and effects of cervical and breast cancer screening in a public hospital emergency room. The Cancer Control Center of Harlem.

OBJECTIVES: This study assessed the cost-effectiveness of cervix and breast cancer screening in a public hospital emergency room. METHODS: Age-eligible women with nonurgent conditions and without recent screening were offered screening by a nurse. A decision analysis compared the costs and outcomes of emergency room screening and standard hospital screening efforts. RESULTS: The undiscounted cost-effectiveness results for establishing new programs were $4050 (cervical cancer), $403,203 (breast cancer), and $4375 (joint cervix and breast cancer) per year of life saved. If screening is added to an existing program, results are more favorable ($429, $21,324, and $479 per year of life saved for cervix, breast, and joint screening, respectively). Results were most sensitive to volume and probability of receiving treatment after an abnormal screen. CONCLUSIONS: Emergency room screening was cost-effective for cervical cancer; breast cancer screening was relatively expensive given the low number of women reached. More intensive recruitment and follow-up strategies are needed to maximize the cost-effectiveness of such programs.

Breast Neoplasms↗
PubMed1997

Schistosomiasis: an unusual cause of right lower quadrant abdominal pain.

Schistosomiasis, although unusual in North America, is a common disease worldwide. Symptoms vary depending on the species involved. Immigrants from endemic regions are the commonly affected patients found in North America. In most cases, schistosomiasis does not present with right lower quadrant pain. Even in endemic regions, this form of presentation is uncommon. In the United States, most cases of right lower quadrant pain often will be treated as appendicitis. Questions remain unanswered as to whether the schistosomes cause appendicitis or are found incidentally in these cases. Stool and urine specimens may be helpful in making a diagnosis. Most cases require operative intervention to rule out appendicitis and to obtain tissue for histopathologic diagnosis. Praziquantel is effective in eradicating infestations.

Abdominal Pain↗
PubMed1996

In vitro percutaneous absorption of benzidine in complex mechanistically defined chemical mixtures.

Little work has been done on the topical absorption of the bladder carcinogen benzidine. Since humans are more likely to be exposed to chemical mixtures than to a single chemical, a program was developed in these laboratories to examine the cumulative effect of complex mixtures on percutaneous absorption of important toxicants such as benzidine. In this investigation, a mixture is defined as a physical combination consisting of a marker chemical and several other chemicals, each of which can have independent and/or synergistic effects on dermal penetration and absorption of the marker chemical. Ten mixtures, consisting of a marker chemical (benzidine, B), a solvent (acetone, A or DMSO, D), a surfactant (0 or 10% sodium lauryl sulfate, SL), a vasodilator (0 or 180 microg methyl nicotinate, M), and a reducing agent (0 or 2% SnCl2, s) were employed in this study. Isolated perfused porcine skin flaps (IPPSFs), which have proven to be a suitable in vitro model for assessing dermal absorption and toxicity, and flow-through diffusion cell systems were utilized. The extent of benzidine absorption in skin sections dosed with either B + A (0.94% dose) or B + D (1.01% dose) was similar to that when IPPSFs were dosed with either B + A (0.54% dose) or B + D (1.31% dose). However, flux vs time profiles were different when the two in vitro methods were compared. For mixtures containing (1) DMSO only or acetone only or (2) solvents containing SL + M, benzidine absorption was enhanced when compared with other mixtures. Compared to acetone, DMSO appears to enhance dermal penetration of benzidine in most of the mixtures. Compared to other mixtures evaluated, SnCl2 inhibited benzidine absorption irrespective of solvent present. SnCl2 also appears to inhibit benzidine penetration in DMSO mixtures containing SL only, but not in acetone mixtures. It is proposed that chemical-chemical interactions between benzidine and SnCl2 may be inhibiting benzidine absorption and chemical-biological interactions between M + SL and skin may be enhancing benzidine absorption. Across all mixtures, maximum observed benzidine absorption was almost 3% of the topical dose over 8 hr, but maximum penetration was 22% over the same time period which would suggest a potential for greater systemic exposure over longer time frames. This work underscores the need to study potentially toxic chemicals in mixture exposure scenarios since the interactions observed would confound risk assessment based on single chemical data.

Animals↗
PubMed1996

Implementation of a breast and cervical cancer screening program in a public hospital emergency department. Cancer Control Center of Harlem.

STUDY OBJECTIVE: To assess the feasibility and yields of screening for breast and cervical cancer in an urban public hospital emergency department. METHODS: Women who presented to the ED of a large, urban public hospital during the study period with nonurgent conditions were eligible for a Papanicolaou test (Pap smear) and a clinical breast examination (CBE) if they were 18 years of age or older and for a mammogram if they were 40 years of age or older, provided they had not had the screening examination within the past year. The Pap smear and CBE were performed by a nurse, and mammography was scheduled for a later date. Women with gynecologic complaints were excluded. RESULTS: On the basis of screening history, medical status, and age, 1,850 (32%) of the 5,830 women seen in the ER during the 23-month study period were eligible for both mammography and CBE, and 2,361 (41%) were eligible for Pap smears. Of these women, 116 (6%) completed mammography and CBE, and 644 (27%) received Pap smears. Among screened women, 10 (9%) and 20 (3%), respectively, had results that were suspicious or positive for breast or cervical cancer. Follow-up rates were low: 20% for breast screening and 50% for Pap smears. Among those receiving follow-up, 1 woman was found to have breast cancer and 8 were found to have cervical neoplasia. CONCLUSION: ED cancer screening was feasible and yielded a high rate of cancer detection. Program efficiency was hampered by low volume and high numbers of patients lost to follow-up after abnormal screening results. Greater integration into the acute care setting and more intensive recruitment and follow-up strategies are needed to maximize the potential yield and cost effectiveness of such programs.

Adolescent↗
PubMed1996

Analysis of germline and expressed T cell receptor variable region genes in Crohn's disease.

A possible role of the T cell receptor genes in the pathogenesis of Crohn's disease was investigated by 1) comparison of restriction fragment length polymorphisms at the T cell receptor beta chain locus in 64 Crohn's patients and 64 normal controls; 2) semi-quantitative polymerase chain reaction analysis of T cell receptor beta and alpha chain variable region gene expression by lamina propria lymphocytes from resected segments of diseased terminal ileum. We found no association between any of the restriction fragment length polymorphisms and Crohn's disease using polymorphic markers spanning the T cell receptor beta chain locus. Analysis of T cell receptor V beta and V alpha gene expression showed that expression of T cell receptor V region families in terminal ileum lymphocytes from patients with active Crohn's disease was indistinguishable from the lymphocytes found in normal terminal ileum. These data fail to support susceptibility to Crohn's disease being associated with the T cell beta chain antigen receptor genotype. No restricted or dominant T cell receptor variable region gene expression was found in Crohn's disease tissue, compared to normal terminal ileum.

Adult↗
PubMed1996

[250 years of English psychiatry].

The history of British psychiatry is considered from five main viewpoints: clinical practice, the institutional basis, the legislative basis, lay perspectives of-mental disorder, and European influences. Its philosophical basis can be traced back to the work of the seventeenth-century philosophers. Thomas Hobbes and John Locke. In Scotland, both 'philosophy of mind' and new clinical methods flourished during its Enlightenment; the concept of 'neurosis' was developed by William Cullen. Around 1800, James Prichard's concept of 'moral insanity' became the foundation of modern work on personality disorder and psychopathy. The psychotic illness of King George III, beginning in 1788, led to greater public sympathy for the mentally ill. Attitudes since then have varied, with 'antipsychiatry' becoming very influential in the 1960s. By the mid-eighteenth century, specialised institutions for the mentally ill existed in a number of cities, there were also units attached to charitable general hospitals, but none of these continued after about 1830. The neglect of patients in private madhouses, prisons, and poorhouses led to increasing concern by Parliament, which resulted in the development of public asylums throughout the country. Severe legal restrictions on their activities were modified in 1930 and completely reformed in 1959. From the mid-nineteenth century, French and German influences became increasingly strong, but British universities played no active part in psychiatry until the 1950s. Psycho-analysis did not develop strongly in Britain, where the main contribution was through translation and biography, but some leading analysts came as refugees in the 1930s-as did other psychiatrists from central Europe. Another important influence was that of Adolf Meyer at the Institute of Psychiatry, London, particularly through Sir Aubrey Lewis; physical treatment methods also came to Britain from Europe. In the second half of this century, the most important British developments have been in social psychiatry therapeutic communities, day hospitals, comprehensive district services, psychogeriatrics, etc. Academic psychiatry has also become strong since the 1960s.

England↗