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Biomedical subjects

L J Freeman

Publications and source records attributed to L J Freeman.

At least 19 recordsLinked to original sources
PubMed1990

Congenital skin diseases.

The purpose of this chapter is to review some of the common congenital and hereditary skin diseases in domestic animals. Alopecia, abnormalities in pigmentation, and structural defects of the dermis are addressed in a problem-solving format. Features of other miscellaneous congenital and hereditary skin diseases are discussed. Specific breed and species involvement and the ages of onset are identified. Modes of inheritance and information on recognizing patterns of inheritance by pedigree analysis are presented. Clinical and pathologic findings important to differential diagnosis of these conditions are summarized. Advanced diagnostic techniques useful in further characterizing these conditions are presented.

Animals↗
PubMed1989

The automatic implantable cardioverter/defibrillator for a life threatening arrhythmia in a case of post-partum cardiomyopathy.

We report the development of severe life threatening polymorphic ventricular tachycardia in a young woman shortly following her first pregnancy, who ultimately required the insertion of an automatic implantable cardioverter/defibrillator because of the failure of conventional antiarrhythmic therapy. Although only about 7 patients have received units in the UK to date, the experience in the USA, where up to 300 per month may be implanted, suggests that they will become a more common method of treatment in cases of life threatening arrhythmias.

Adult↗
PubMed1988

The 'think test': a further technique to elicit hyperventilation.

Hyperventilation can undermine cardiovascular homeostasis by generating autonomic imbalance, sympathetic dominance, hypokalaemia, and intracellular alkalosis with calcium ion shifts. The role of hyperventilation in episodic disorders such as arrhythmia and coronary vasospasm can be difficult to identify if the patient does not present in an attack and so a provocation challenge is required. Today, the standard challenge is the forced hyperventilation provocation test (FHPT). A capnograph enables the resting end-tidal PCO2 to be compared with the level 3 min after the period of overbreathing. We report the use of a patient-specific challenge. After the FHPT, the subject is invited to close his eyes and think about the circumstances of an attack, feelings and sensations experienced (breathing is not mentioned) or topics that were seen to disturb the rhythm of breathing when the medical history was taken. A fall of end-tidal PCO2 of 10 mmHg or more lasting at least one minute was taken as a positive response. Out of 57 patients with cardiovascular symptoms suggesting a hypocapnic influence, resting hypocapnia (end-tidal PCO2 = 30 mmHg) was present in 3 (5%). Of the remaining 54, the FHPT was positive in 16 (30%) and the 'think test' in 33 (61%). This suggests that patient-specific stimulation has advantages over an unspecific challenge in testing for episodic hypocapnia.

Adult↗
PubMed1987

Psychological stress and silent myocardial ischemia.

Episodes of transient myocardial ischemia during daily life were investigated in 30 patients on two separate occasions, by ambulatory Holter ST monitoring. The first occasion was at a time of uncertainty in the patients' lives, when the results of coronary angiography and the need for surgery were to be discussed. The second was at a later date, when there had been time to adjust to the decision-making process. There were 515 episodes of myocardial ischemia of which 174 were associated with pain and 341 were asymptomatic. Silent ischemia was significantly more frequent during the first period of monitoring compared to the second (p less than 0.02). Patients who had more silent ischemia on the first occasion also entered more self reports of "emotional upset" (tension, worry, etc.,) in their diaries compared to the second occasion. The level of urinary cortisol was taken as a measure of uncertainty and worry, and was significantly higher on the first occasion (p less than 0.03). Differences in urinary noradrenaline excretion were taken as a measure of subjective stress. Patients who excreted more noradrenaline on the first compared to the second occasion had significantly more silent ischemia (p less than 0.007) and longer total ischemic time (p less than 0.01). We suggest that psychological stress may exacerbate myocardial ischemia which is frequently painless.

Activities of Daily Living↗
PubMed1987

The effect of the type A behaviour pattern on myocardial ischaemia during daily life.

Twenty-eight subjects completed 2 Type A questionnaires. Just under half the patients were considered Type A. Painful episodes of myocardial ischaemia occurred more frequently in Type A patients during a stressful period of ambulatory Holter monitoring compared to a later date. This difference could not be explained in terms of severity of disease or length of myocardial ischaemia. Rather it seemed to reflect increased reporting of somatic symptoms on the background of a greater sensitivity to environmental stress. Type A patients may thus present themselves earlier than their Type B peers.

Activities of Daily Living↗
PubMed1987

Hyperventilation and Raynaud's disease.

A 42 year old woman with long standing Raynaud's disease, unresponsive to medical and surgical treatment, was noted to have a typical history of the hyperventilation syndrome. Rewarming of the hands following cold challenge was markedly prolonged in the presence of hypocapnia. It is suggested that hyperventilation may have an aetiological role in maintaining digital artery spasm in Raynaud's disease, which would benefit from recognition and treatment.

Adult↗
PubMed1987

Role of the nurse counsellor in managing patients with the hyperventilation syndrome.

A hyperventilation clinic was established specifically to deal with patients referred from the accident and emergency department with the hyperventilation syndrome. This was run by a staff nurse, who counselled the patients and taught abdominal breathing techniques and relaxation. In 30 patients so managed, 63% said their symptoms were much better or had completely gone and in only 6% was there no improvement; 43% had previously had more than one attendance at the A&E department, but following treatment only 2 patients represented during 5 months of follow up. The use of a nurse counsellor seems to be a simple and effective approach to managing these patients and considerably reduces both casualty and outpatient physician time.

Adolescent↗
PubMed1987

Time to rethink the clinical syndrome of angina pectoris?--Implications from ambulatory ST monitoring.

Thirty patients with severe symptomatic coronary artery disease were studied with two 48-h periods of ambulatory ST Holter monitoring. In common with other groups, there was a much higher incidence of asymptomatic (341 or 66.2 per cent) than symptomatic (174 or 33.8 per cent) ST segment depressions. Seventy-eight (15.1 per cent) of the ST segment depressions occurring in the absence of angina pain (and hence termed asymptomatic) were actually associated with other somatic sensations such as breathlessness and emotional upset. Reported disorders of sleep and poor energy levels were also associated with more ischaemic events. The view is presented that it is no longer adequate to obtain a classical history of angina pectoris for this poorly reflects the ischaemic myocardium. It is the functional capacity of the pump rather than the appearance of the rigid narrowings of the coronary arteries that is of importance both for the patient and the left ventricle. Further the role of mental upset occurring in daily life appears increasingly important in the aetiology of silent myocardial ischaemia. Recognition of this and appropriate counselling of the patient is important.

Angina Pectoris↗
PubMed1986

Heart rate response, emotional disturbance and hyperventilation.

The heart rate and electrocardiographic responses were documented in 40 subjects undergoing hyperventilation provocation tests. Forced overbreathing produced a similar mean heart rate increase in all subjects, regardless of whether the result of the provocation tests suggested the hyperventilation syndrome. In contrast subjects diagnosed as hyperventilators by virtue of prolonged hypocapnia in response to psychological provocation showed significant increased heart rate responses compared to the remaining subjects (p less than 0.001). Significant electrocardiographic abnormalities were also produced. The view is presented that the hypocapnia may allow persistence of the cardiovascular responses in the presence of emotional challenge.

Adult↗
PubMed1986

Physiological responses to psychological challenge under hypnosis in patients considered to have the hyperventilation syndrome: implications for diagnosis and therapy.

Thirty patients who were considered to have the hyperventilation syndrome on clinical grounds (history and observation) were referred for testing: 29 patients completed a forced hyperventilation provocation test, and 28 underwent hypnosis during which time a psychological challenge was introduced which was meaningful to each individual patient. In 19/27 of these patients the PetCO2 fell by an average of 18.2 mmHg and persisted spontaneously for more than three minutes. In 10 normal controls studied in a similar fashion there was an average fall of 5 mmHg. The difference in response between responders and controls/non-responders was highly significant (P less than 0.001). A review of the literature is presented for comparison. It is considered that a psychological challenge under hypnosis may have important implications for diagnosis and therapy in some patients considered to have the hyperventilation syndrome.

Adult↗
PubMed1985

Are coronary artery spasm and progressive damage to the heart associated with the hyperventilation syndrome?

A case of coronary artery vasospasm was studied in a man with a four year history of angina. He had evidence of symptomatic hyperventilation during a spontaneous episode of chest pain. When asked to hyperventilate the pain in his chest and ST elevation were reproduced in the same leads as occurred during the spontaneous attack. This may be the first reported case of spontaneous hyperventilation producing vasoconstriction, and the patient's previous admissions to the coronary care unit may have been associated with coronary vasospasm induced by hyperventilation. When patients with variant angina report pains in the chest in association with dizziness and breathlessness hyperventilation should be considered to be a possible cause of the symptoms. As coronary vasospasm is increasingly implicated in angina after myocardial infarction the role of hyperventilation should be considered more often.

Angina, Unstable↗