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Biomedical subjects

H Freeman

Publications and source records attributed to H Freeman.

At least 55 records · Page 3Linked to original sources
PubMed1990

Lymphocytic gastritis in patients with celiac sprue or spruelike intestinal disease.

A distinctive form of gastritis, characterized by lymphocytic infiltration of pit epithelium, has recently been described in association with evidence of Campylobacter pylori infection. We have evaluated simultaneous small bowel and gastric biopsies from 22 patients with diarrhea or malabsorption, all of which showed small bowel changes characteristic of sprue or spruelike disease. In 10 of 22 patients, striking lymphocytic gastritis was identified. Cases positive for lymphocytic gastritis had a mean of 46.5 lymphocytes per 100 epithelial cells, compared with a mean of 3.5 in normal gastric controls and 5.1 in abnormal controls, including cases with Campylobacter gastritis. Concurrent small bowel biopsies had a mean of 47.2 lymphocytes per 100 epithelial cells. Cases without lymphocytic gastritis had means of 10.8 and 39.9 lymphocytes per 100 gastric and intestinal epithelial cells, respectively. Campylobacter organisms were identified in only 1 of the 10 patients with lymphocytic gastritis and in 3 of the 12 patients without lymphocytic gastritis. Intraepithelial lymphocytes in small bowel and stomach were positive for the antibody MT-1, indicating a T-cell infiltrate at both sites. These findings suggest that lymphocytic gastritis may occur as a manifestation of celiac sprue or spruelike disease and that the lymphocytic infiltration of celiac sprue may affect gastric epithelial mucous cells.

Biopsy↗
PubMed1990

Colonic lymphocytosis in patients with celiac sprue.

We examined colonic biopsies from 39 patients with clinical and small bowel biopsy changes of celiac sprue. In 12 of 39 patients (31%), striking lymphocytic infiltration of the superficial colonic epithelium and chronic inflammation of the lamina propria were identified. These 12 cases had a mean of 30.4 lymphocytes per 100 superficial colonic epithelial cells, compared with means of 8.4 in sprue cases without colonic epithelial lymphocytosis, 4.8 in normal controls, and 32.4 in nine cases of lymphocytic colitis without concurrent celiac sprue. No case showed subepithelial collagen layer thickening. Four patients with celiac sprue and colonic lymphocytosis also had gastric biopsies; two showed gastric lymphocytosis. Intraepithelial lymphocytes at all sites were positive for the T-cell marker MT-1. These findings indicate that sprue-associated colonic lymphocytosis and lymphocytic colitis are histologically, quantitatively, and immunohistochemically indistinguishable, that the epithelial T-cell infiltration of celiac sprue occurs in glandular mucosa at all levels of the gastrointestinal tract, and that colonic subepithelial collagen deposition in patients with celiac sprue is an infrequent occurrence. These findings also suggest that gastrointestinal epithelial T-cell infiltration may be an immunologic response that is common in individuals sensitized to absorbed lumenal antigens, and that colonic lymphocytosis may occur as a response to a number of antigens, including gluten.

Celiac Disease↗
PubMed1989

Community management of schizophrenia. A two-year follow-up of a behavioural intervention with families.

The relapse and readmission rates of schizophrenic patients who participated in a controlled trial of a nine-month behavioural family intervention trial based on the EE status of their relatives are presented at two years. The patients who received the behavioural family intervention had lower rates of relapse and readmission than patients from high-EE homes who had received a short educational programme or routine treatment. The relapse rate of the behavioural family intervention group (33%) was the same as that of the low-EE group (33%), and significantly lower than that of the non-intervention high-EE group (59%).

Behavior Therapy↗
PubMed1989

Malnutrition: an important determinant of fatal outcome in surgically treated pulmonary suppurative disease.

Eighty patients required surgical drainage of infections in the pleural space or lung during a four-year period (1984-1987). Thirty-nine patients had a history of heavy intravenous drug use and 28 of those not addicted to drugs were addicted to alcohol. Impaired immunity was believed to be present in 72 (90%) due to malnutrition (45 patients), acquired immunodeficiency syndrome (AIDS) or AIDS-related complex (13), hepatic cirrhosis (1), diabetes (1), or multiple causes (12). Sixty-four patients had acute purulent empyema; 9, tuberculous empyema (often a mixed infection); 2, tuberculous pleural effusion with complications; 2, lung abscesses requiring open drainage; 2, chronic bronchopleural fistulae; and 1, empyema secondary to an esophageal perforation. Fifty-three (66%) were treated with tube thoracostomy only and 27 required additional procedures, including open drainage (19 patients), decortication (5), lung resection (2), chest wall resection (1), and parietal pericardiectomy (1). Overall mortality was high (30%); mortality had a strong correlation with malnutrition or immune deficiency. Very low serum albumin levels were common and were the most important single determinant of a fatal outcome: (table; see text) Other important determinants of mortality were: total lymphocytes less than 1000 (50% mortality); anergy to tests for delayed hypersensitivity (39% mortality); AIDS or AIDS-related complex (54% mortality). Analysis of the records of the 24 patients who died has led to the conclusion that despite the advanced disease present and the poor condition of most patients at least one third of the deaths could have been avoided if important errors in diagnosis and medical or surgical management could have been prevented.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Malignant peritoneal mesothelioma after remote abdominal radiation.

Peritoneal mesothelioma in a 61-year-old man, occurred 26 years after abdominal radiotherapy for a testicular seminoma. The patient had no history of asbestos exposure. After asbestos, radiation is the second most frequent defined cause of mesothelioma in North America, but the number of well-documented cases is small; this case represents only the fifth example of peritoneal mesothelioma after therapeutic irradiation of the abdomen.

Combined Modality Therapy↗
PubMed1988

A cohort study of psychosurgery cases from a defined population.

All cases from an urban population treated by psychosurgery over a 20 year period were followed up; 44 out of 47 were available for study, and 33 of these were interviewed. Outcome was measured on a five-point scale, and follow-up was from 1 to 20 years, with a mean of 11; almost all patients previously had had severe, disabling and intractable illnesses. Operations were non-stereotactic (36), stereotactic (6), with double procedures in one case: outcome was better in the non-stereotactic group. On a five-point scale of outcome, 25 of the 33 interviewed patients were placed in the two best categories, as were eight patients of the 11 who were assessed by case records. Adverse effects were reported in 14 cases, but most were not serious. Only one death could definitely be related to operation. Depression, agoraphobia, obsessional neurosis, and certain aspects of schizophrenia all responded well in the majority of cases. Leucotomy should remain available as a treatment of last resort for some intractable psychiatric disorders.

Adult↗
PubMed1988

The community management of schizophrenia. A controlled trial of a behavioural intervention with families to reduce relapse.

Schizophrenic patients were recruited into a trial of a prophylactic behavioural intervention with families. Families with at least one high Expressed Emotion (EE) relative were randomly allocated to one of four intervention groups: Behavioural Intervention Enactive; Behavioural Intervention Symbolic; Education Only; Routine Treatment. Patients from low-EE families were randomly allocated to two groups: Education Only or Routine Treatment. Relapse rates over nine months after discharge were significantly lower for patients in the two Behavioural Intervention, compared with Education Only and Routine Treatment groups. There was little difference between the two low-EE groups. Patients returning to high-EE relatives showed significantly higher relapse rates than those returning to low-EE relatives, in groups not receiving active intervention. Changes from high to low EE occurred in the Behavioural Intervention groups, and similar although less extensive changes occurred in the Education Only and Routine Treatment groups. Changes in criticism and marked emotional over-involvement (EOI) occurred generally in high-EE groups but were larger in magnitude in the Enactive and Symbolic groups. Reduction of hostility only occurred in the Behavioural Intervention groups. These results give partial support for the causal role of EE in relapse. There were no significant differences between the groups with respect to contact with the psychiatric services or medication.

Adult↗
PubMed1986

Prevalence of schizophrenia in an urban population.

The treated one-year prevalence and point-prevalence of schizophrenia, schizoaffective psychosis, and paranoid state in the city of Salford were derived from the Salford Psychiatric Case Register. The high rates found are attributed primarily to the effects of selective migration from the area. A breakdown of the use of health services in the area by patients with these diagnoses is given; hospital care was found to be the major form of treatment.

Adolescent↗
PubMed1985

Water intoxication in psychiatric patients.

Compulsive water drinking is associated with a broad spectrum of psychopathology, from mild neurosis to psychosis. Since the normal kidney is capable of excreting large volumes of fluid rapidly, water intoxication requires both a pathological basis and a psychiatric explanation of why so much water is being taken. Excessive water consumption can be dangerous, so that the fluid intake of patients with a history of polyuria together with a low urinary specific gravity should be closely observed. Four cases of water intoxication resulting from psychogenic polydipsia are described, three of them in chronic schizophrenics, where inappropriate ADH secretion might represent part of the psychosis.

Adult↗
PubMed1984

Psychiatric abnormality and brain calcification over four generations.

An association between basal ganglia calcification and psychiatric abnormality, mainly schizophrenia, is described in three generations of a family; schizophrenia is also recorded in the previous generation. The mode of inheritance appears to be an X-linked dominant one. Unusual sensitivity to neuroleptics also occurred in four members of the family. No comparable family study is believed by the authors to have been reported previously.

Adolescent↗
PubMed1984

Social characteristics of newly admitted mental hospital patients--a replication study.

Data were examined on all patients entering the admission wards of a large provincial mental hospital in 1979. Out of a total of 534 admissions, 470 came from permanent addresses, most of the rest from supportive accommodation or transitory addresses, while less than 2% were of no fixed abode. Only 73 of the sample, mostly aged over 60 years remained in hospital after a year: 17 died and 444 were discharged. Of the discharged patients, 45(10.3%) could not return to their original addresses. Comparison is made with the results previously reported from a London mental hospital.

Hospitals, Psychiatric↗