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Biomedical subjects

J L Freeman

Publications and source records attributed to J L Freeman.

At least 19 recordsLinked to original sources
PubMed1995

Transclavicular approach to the neck, thoracic inlet, and axilla.

OBJECTIVE: To describe claviculotomy and claviculectomy for access to lesions of the lower part of the neck, with simultaneous reconstruction. METHODS AND MATERIALS: A retrospective review of 15 patients who underwent claviculotomy for access to the lower part of the neck. RESULTS: Eight patients underwent plate reconstruction, and one patient required subsequent removal. Three patients underwent total claviculectomy, and four patients underwent partial claviculectomy. Ten patients are alive and free of disease, three have died of disease, and two are alive with disease. All but two patients are satisfied with shoulder function, and one patient is dissatisfied with the cosmetic result. CONCLUSIONS: The claviculotomy and claviculectomy technique for tumors that transgress the neck, thoracic inlet, and axilla offers maximal exposure for excision, vascular control, and preservation of vital structures. Modern plating techniques have allowed clavicular reconstruction with improved cosmesis and preservation of shoulder stability.

Adult↗
PubMed1995

Expression of growth factors and growth factor receptors in normal and tumorous human thyroid tissues.

A number of growth factors have been implicated as stimuli of thyroid cell proliferation; overexpression of these growth factors and/or their receptors may play a role in the growth of thyroid tumors. To determine if immunohistochemical detection of growth factors and/or their receptors correlates with morphological alterations in proliferative lesions of thyroid, we examined the localization of epidermal growth factor (EGF), transforming growth factor-alpha (TGF-alpha) and their common receptor, EGF-receptor (EGF-R), insulin-like growth factor-1 (IGF-1), IGF-1-receptor (IGF-R) and IGF binding proteins (IGFBP)-1, -2, -3, and -4, nerve growth factor (NGF), and its receptor NGF-receptor (NGF-R), transforming growth factor-beta (TGF-beta), and basic fibroblast growth factor (bFGF), in normal thyroid tissue and various thyroid tumors. We applied the streptavidin-biotin technique to formalin-fixed, paraffin-embedded tissues. We studied 8-16 different cases of each of the following: normal human thyroid, multinodular hyperplasia, follicular adenoma, papillary carcinoma, follicular carcinoma, medullary carcinoma, and anaplastic carcinoma. EGF, TGF-alpha, and their receptor EGF-R were widely expressed in normal thyroid and in all the thyroid lesions examined. IGF-1 and IGFBP-1 were diffusely present in all different thyroid tissues as well. There was no difference in staining intensity or distribution that correlated with the pathological process. IGFBP-4 seemed to have a variable expression. IGFBP-2 and -3 were detected only in medullary carcinomas.(ABSTRACT TRUNCATED AT 250 WORDS)

Carrier Proteins↗
PubMed1995

Diagnosis-related group refinement with diagnosis- and procedure-specific comorbidities and complications.

Diagnosis-related groups have been revised through more refined uses of secondary diagnoses. Under the refined diagnosis-related groups, patients are distinguished with respect to classes of secondary diagnoses that are disease- and procedure-specific. Each class represents a different level of utilization for a given principal diagnosis or surgical procedure. The refined system was evaluated with national data from the Medicare program. Estimates of hospital costs and utilization based on refined diagnosis-related groups were more precise than those based on unrefined diagnosis-related groups. This approach to diagnosis-related group refinement does not represent a radical departure from the current diagnosis-related group framework and does not require new data collection efforts. Moreover, a payment system based on the refined model is less affected by the ordering of the diagnoses than under the existing diagnosis-related group system. How the refined diagnosis-related group framework can accommodate future refinements at all levels of the classification scheme is also discussed.

Adult↗
PubMed1995

Childhood lead poisoning in Massachusetts communities: its association with sociodemographic and housing characteristics.

OBJECTIVES: The purpose of the study was to examine the relationship between communities' sociodemographic and housing characteristics and incidence of lead poisoning. METHODS: This was a population-based correlational study of 238,275 Massachusetts children from birth through 4 years of age who were screened for lead poisoning in 1991-1992. A logistic regression model was developed with the community as the unit of analysis, the case identification rate for lead poisoning (newly identified children with venous blood lead > or = 25 micrograms/dL per 1000 children) as the dependent variable, and US census variables as independent variables. RESULTS: A significant independent relationship with the community case identification rate of lead poisoning was found for seven variables: median per capita income, percentage of housing built before 1950, percentage of the population who were Black, percentage of children screened, and a "poverty index." Rates of iron deficiency and percentage of Hispanics were not associated with the case identification rate of lead poisoning. CONCLUSIONS: Massachusetts communities' incidence of lead poisoning is correlated with sociodemographic and housing characteristics. In states similar to Massachusetts and without screening data, this model may help target screening programs.

Black or African American↗
PubMed1995

Mediastinal obstruction of the trachea.

Acute tracheal obstruction by a mediastinal mass is uncommon in otolaryngologic practice. Choosing techniques for securing the airway, induction of anaesthesia, and the surgical approach require careful deliberation. We report our experience in a patient with acute respiratory distress due to external compression of the trachea in the mediastinum by metastatic carcinoma. We used a fibre-optic bronchoscope ensheathed by an endotracheal tube to secure the airway. Standard tracheotomy tubes were too short to splint open the obstruction in the distal trachea, whereas the long Montgomery T-tube was effective.

Acute Disease↗
PubMed1994

Beta blocker use in the treatment of community hospital patients discharged after myocardial infarction.

OBJECTIVE: To explore the reasons for underutilization of beta blocker treatment after acute myocardial infarction. DESIGN: A retrospective chart review. SETTING: Two large community hospitals in Milwaukee, Wisconsin. PATIENTS/PARTICIPANTS: All subjects (n = 694) discharged alive from July 1, 1990, to June 30, 1991, who had a diagnosis of acute myocardial infarction were eligible. Of these, 250 had missing data, resulting in a final sample of 444. RESULTS: Twenty-nine percent of the 444 patients were prescribed beta blocker therapy on discharge. Characteristics of the patients and their treatment associated with receipt of beta blocker therapy were identified with a logistic regression model. The adjusted odds ratios were 0.52 for female gender, 0.34 for no health insurance, 0.21 for chronic obstructive pulmonary disease, 0.46 for congestive heart failure, 0.28 for atrioventricular block, 1.86 for hypertension, 1.93 for chest pain during acute myocardial infarction, and 4.65 for prehospital beta blocker use. Prescription of beta blocker therapy was also influenced by receipt of other treatment modalities. The adjusted odds ratios were 0.23 for receipt of beta blocker therapy associated with myocardial revascularization, 0.18 for prescription on discharge of calcium channel blockers, and 0.22 for receipt of angiotensin-converting enzyme inhibitors. CONCLUSION: A minority of patients discharged after acute myocardial infarction receive beta blocker therapy, and women are only half as likely as men to receive it, after controlling for other factors. Though there are no data relating to whether calcium channel blockers or angiotensin-converting enzyme inhibitors lessen the protective effect of beta blocker therapy post-acute myocardial infarction, it would appear that these agents are frequently being used in lieu of beta blocker therapy for post-acute myocardial infarction patients.

Adrenergic beta-Antagonists↗
PubMed1994

The through-and-through oromandibular defect: rationale for aggressive reconstruction.

Through-and-through oral cancer (T4+) involving contiguous mucosa, mandible, and skin is a devastating disease with poor prognosis and represents one of the most difficult reconstructive challenges in head and neck surgery. Thirty-eight patients underwent immediate microvascular reconstruction following surgical tumor ablation. The purpose of the present review was to assess the value of microvascular reconstruction in these essentially palliative reconstructive efforts. The iliac crest osteocutaneous flap was used in the majority of patients and was found to be ideal for the reconstruction of large bony and soft-tissue defects present in this group of patients. Other methods, including pectoralis major, forehead, and latissimus dorsi flaps, also were used in the soft-tissue reconstruction. The mean follow-up was 16 +/- 2 months, and the mean hospitalization was 43 +/- 22 days. The majority of patients succumbed to recurrent or related diseases, yet a few went on to survival despite the initial advanced stage of disease. A number of complications were observed. However, most patients developed normal or easily intelligible speech (65 percent), and most (78 percent) had their tracheostomies closed and sustained themselves on an oral soft diet (84 percent). Bony union was noted in the majority of patients (73 percent). Although the prognosis in full-thickness oral carcinoma is grim, it appears that palliative surgery in these cases is well justified. The goals are to shorten the duration of hospitalization, reduce morbidity, and improve the remaining quality of life. Microvascular tissue transfer offers a means to achieve these goals in a single, reliable procedure. We feel that immediate one-stage bone and soft-tissue reconstruction restores dignity and relieves suffering in this unfortunate group of individuals.

Adult↗
PubMed1992

Diagnosis of nasopharyngeal carcinoma by DNA amplification of tissue obtained by fine-needle aspiration.

BACKGROUND: In nasopharyngeal carcinoma the primary lesion is often difficult to find. Metastatic lesions occur frequently but are difficult to distinguish from other head and neck tumors. The viral genome of the Epstein-Barr virus (EBV) can be identified in the cells of this carcinoma. METHODS: We used the polymerase chain reaction (PCR) to test for the presence of EBV genomes in 15 samples of metastatic squamous-cell carcinoma of the neck obtained by fine-needle aspiration and in 26 samples obtained by biopsy of lymph nodes. For controls we used disease-free lymph nodes from 10 patients with various head and neck tumors, tonsillar tissue from 46 subjects, blood from 59 EBV-seropositive blood donors, and mononuclear cells from 8 patients with fatal lymphoproliferative lesions. RESULTS: Of the 41 malignant lesions examined, only the nine nasopharyngeal carcinomas (one primary lesion and eight metastases) contained EBV genomes. None of the 20 nodes with other types of cancer, the 10 disease-free nodes, or any of the 105 normal control samples contained detectable EBV. In two patients with suspected metastases from occult primary tumors, the presence of EBV was predictive of nasopharyngeal carcinoma; in both cases overt nasopharyngeal carcinoma developed within one year. CONCLUSIONS: In patients with suspected nasopharyngeal carcinoma, fine-needle aspiration can provide tissue for diagnosis by DNA amplification of EBV genomes. The presence of EBV in metastases from an occult primary tumor is predictive of the development of overt nasopharyngeal carcinoma.

Base Sequence↗
PubMed1992

Detection of occult nasopharyngeal primary tumours by means of in situ hybridization.

Detection of nasopharyngeal carcinoma primaries in patients presenting with neck node metastases may sometimes demand considerable efforts. By using the 'in situ hybridization' technique, we manage to identify the Epstein-Barr virus in neck metastases secondary to nasopharyngeal carcinomas. We propose that such identification in neck node metastases where the primary lesion is unknown indicates a nasopharyngeal primary.

DNA, Viral↗
PubMed1992

Ethmoidectomy decompression for the treatment of Graves' optic neuropathy.

When orbital decompression becomes necessary in Graves' optic neuropathy, medial wall decompression is a necessary component of the decompression procedure. The ethmoidectomy approach allows more direct visualization of the posterior ethmoids and sphenoids to effect maximum decompression. This is particularly important in cases in which computed tomography shows the medial rectus muscle to be enlarged posteriorly in the orbit. The procedure provides excellent visualization of the medial rectus. As with any medial wall decompression procedure, postoperative restriction of horizontal motility is a frequent complication, often necessitating more than one subsequent operation. The authors describe their experience with the procedure in 25 patients with Graves' optic neuropathy.

Adult↗
PubMed1992

Pleomorphic adenoma: a preliminary histopathologic comparison between tumors occurring in the deep and superficial lobes of the parotid gland.

Twenty-four cases of pleomorphic adenoma of the parotid gland were retrospectively reviewed. The histopathological features of capsular thickness, penetration and completeness, tumoral cell population and mitotic activity were analyzed in twelve superficial lobe and twelve deep lobe tumors. The capsules were found to be significantly thicker and less likely to be penetrated by tumor in the deep lobe group. No significant differences in completeness of encapsulation, cell population or mitotic activity were found between the two groups. This may explain the clinical suggestion that the less aggressive surgical approach which is often performed does not compromise the prognosis for recurrence in the deep lobe lesions.

Adenoma↗
PubMed1992

AIDS-related Kaposi's sarcoma of the sphenoid sinus.

The head and neck region is frequently involved by AIDS-related Kaposi's sarcoma, the oral cavity being the most common site of occurrence. We report on the first case of AIDS-related Kaposi's sarcoma involving the sphenoid sinus where radionuclide bone scanning and MRI were effective in suggesting the diagnosis.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Use of free auricular composite graft in nasal alar/vestibular reconstruction.

Reconstruction of the nasal alar/vestibular complex following trauma or surgery presents a challenging problem. Options include bone, cartilage, and composite grafts as well as prosthetic materials. We present a case in which resection of an intranasal leiomyosarcoma, leaving a dome defect, was successfully reconstructed with an auricular composite graft.

Ear Cartilage↗
PubMed1992

Orbital hemorrhage during dacryocystorhinostomy.

Orbital hemorrhage during dacryocystorhinostomy (DCR) is a very rare but potentially devastating complication of this procedure. It is probably due to trauma to the anterior ethmoidal artery, which has a variable course and may have branches close to or in the surgical site. Increasing resistance to retropulsion of the globe is an important sign of orbital hemorrhage. If the hemorrhage does not resolve spontaneously, direct decompression of the blood within the orbit is necessary. The authors review their experience with this complication of DCR.

Dacryocystorhinostomy↗
PubMed1991

Clinical and imaging features of rhabdoid tumor of the kidney.

Rhabdoid tumor of the kidney (RTK) is a rare, highly malignant neoplasm of childhood. The clinical profile of this neoplasm differs from that of Wilms' tumor. We present two cases of RTK. In both our cases, large bulky masses with poorly defined margins and calcifications were demonstrated. The clinical and imaging findings are compared with other childhood renal neoplasms.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1991

The use of tissue expansion in nasal reconstruction.

The reconstruction of subtotal and total losses of the nose involves the use of local and regional flaps from a variety of areas. The forehead flap, using either a Converse reconstruction or a midline glabellar reconstruction, has been widely used for large losses. In order to obviate this type of reconstruction, we have used tissue expansion to gain large flaps for large defects. Our technique and three representative cases are presented.

Aged↗