Biomedical subjects
Publications and source records attributed to S Freed.
We examined the recollection of traumas in panic disorder patients with and without history of nocturnal panic attacks. From a sample of 154 patients seeking treatment for panic disorder, almost 85% of those with nocturnal panic reported a history of traumatic events in comparison to only 28% without nocturnal panic. Fear of loss of vigilance is considered as a potential mediator of the relationship between nocturnal panic and traumatic events.
Patients with traumatic brain injury (TBI) frequently exhibit varied forms of visual system dysfunction including: binocular, oculomotor, accommodative, refractive error shift, visual field loss, and visual perceptual deficits. A 5-year collaborative study between optometry and ophthalmology was initiated to follow documented mild TBI patients utilizing diagnostic methods to assess the quantity and quality of visual system deficits and recovery. A group of patients with mild TBI receiving optometric rehabilitation were compared with a group of age-matched, gender-matched, and headsize-matched TBI patients not receiving such treatment. Eighteen patients diagnosed with mild TBI underwent a treatment regimen of optometric rehabilitation (group I); 32 patients diagnosed with mild TBI did not receive optometric rehabilitation (group II). Pattern visually evoked cortical potential (VECP) testing and electroretinography (ERG) evaluation were utilized initially, repeated 6-12 months later and then 12-18 months after baseline. All TBI patients' VECP and ERG results were compared to age-matched, headsize-matched controls. Once the ERG had been used to exclude retinal involvement, identification of visual pathway dysfunction was possible with the VECP. Full-field ERG results in all groups were not remarkable and not sensitive for patients with mild TBI. Initial testing results revealed that 72% of those TBI patients in group I demonstrated VECP waveform abnormalities and 81% of those patients in group II showed waveform dysfunction. In the testing performed 12-18 months later, 38% of group I TBI patients, after receiving a treatment regimen of optometric rehabilitation, showed VECP waveform abnormalities; 78% of group II TBI patients demonstrated waveform abnormalities. VECP evaluation in patients with mild TBI can provide a useful and reliable tool for objective assessment of visual system deficit and recovery. Significant differences in visual system recovery were shown when comparing group I and group II.
Expectations about arousal were examined in relation to nocturnal panic (NP). Eighteen panic disorder patients suffering from NP attacks and 18 control individuals were assigned randomly to conditions in which they were informed that audio feedback signals reflected heightened arousal that was either (a) expected and harmless or (b) unexpected. Participants relaxed and slept for 45 to 60 min, followed by presentation of periodic audio feedback signals. Physiological recording was continuous while subjective measures were collected at completion of the signals phase. NP patients in the unexpected--no reassurance condition were significantly more anxious and symptomatic than their counterparts in the expected reassurance condition, whereas control individuals did not differ across the 2 conditions. Physiological and behavioral data were less consistent than subjective measures. The results are interpreted as supportive of a cognitive-behavioral model of NP.
BACKGROUND: Patients suffering from a traumatic brain injury (TBI) show many types of visual dysfunctions, including binocular, oculomotor, accommodative and visual field loss. This study evaluates the visual status of patients suffering a mild TBI. METHODS: The visual findings of a control group of 16 non-TBI patients are compared to the visual findings of 16 patients with documented mild TBI. Functions compared include symptomology, refractive status, stereopsis, ocular alignment by cover test, relative accommodation, pursuits, near point of convergence break and recovery, phorias at distance and near and vergence ranges at distance and near. RESULTS: Significant differences were found between the two groups in the areas of refractive status, near point of convergence break/recovery, near cover test, stereo acuity and base-in break at distance. There were also significant differences in symptomology, pursuit function, base-in recovery at distance, base-in break/recovery at near and base-out recovery at distance. CONCLUSIONS: In-depth visual evaluation of mild TBI patients is critical for documentation purposes as well as for possible treatment regimens.
Thirty-five patients being treated for one of three anxiety disorders were asked to rate the likelihood of a negative outcome prior to entering a feared situation, while in the situation and after leaving the situation. Ratings made in anticipation were consistently higher than ratings made either in the situation or after leaving it. In contrast, normal Ss, about to undertake tourist rides perceived as being mildly dangerous, rated the likelihood of negative outcome as highest when actually in the situation.
Detailed functional isomorphism had been observed (Freed, 1984) between induced (conditioned) immunogenicity and classical conditioned defensive reflexes, possibly as evolutionary adaptation against danger at micro and macro levels respectively. Similarly, functional isomorphism is postulated between conditioned specific tolerogenicity of the immunotolerance system and behavioral reflexes. Isomorphism requires that sensory signals elaborated with intrinsic (unconditioned) behavioral tolerogens as carriers do not subsequently combine classically with unconditioned aversive stimuli and evoke conditioned defensive responses. Unconditioned behavioral tolerogenic carriers were identified with behavioral (physiological) activities of Oriental meditation. Confirmation of conditioned behavioral tolerogenicity appeared in the unresponsiveness of Yogi mediators to sensory stimuli as reflected in unchanged alpha rhythms of their encephalograms. Conditioned behavioral specific unresponsiveness maintains the "quiet" of meditation and mediates the experience of Zen mediators, namely, sharpened, clearer perceptions and unresponsiveness to aversive components of current conditioned signals ordinarily reactivating residues of affect. Conditioned behavioral specific unresponsiveness has survival value.
Functional isomorphism holds between four essential properties of acupuncture and of meditation, namely, 1) alpha rhythm prominent in electro-encephalograms (EEG); 2) deep general relaxation; 3) high degree of unresponsiveness to ordinarily painful stimuli; 4) participation of virtually the entire body. It is postulated, subject to experimental test, that a "stillness" prevails during acupuncture similar to the quiet of meditation. The quiet of meditation and by postulate, the "stillness" of acupuncture, provide high degree of unresponsiveness to aversive components of conditioned stimuli which had habitually reactivated affective trauma. This marked unresponsiveness accounts for the "stillness" and its EEG alpha rhythm. With its low noise level the "stillness" also provides the cerebral cortex better resolved, more intense signals relative to background and more comprehensive, clear information. The cortex can then call upon newly mobilizable, more precise regulation for removing imbalances throughout the body. The same factors apply to the therapy by acupuncture of phantom limb pain syndrome if the pain impulses from the limb, while attached, is the unconditioned stimulus of a reflex in which impulses from inner organs function as conditioned stimuli. Successful therapy of the syndrome using laser-stimulated acupuncture points is discussed accordingly. Emphasized is the desirability to maximize the "stillness," possibly by monitoring the course of therapy by displayed EEG.
Changes taking place in both Qi Gong Masters and their patients during Qi Gong treatment were evaluated using the Bi-Digital O-Ring Test. During the Qi Gong state, on the Qi-Gong Master's body, as well as the body of the patient being treated, acupuncture points CV5 (Shi Men) and CV6 (Qi Hai)-- located below the umbilicus-- show changes from +4 in the pre-Qi Gong state to between -3 and -4 during the Qi Gong state. Before and after the Qi Gong, there is a normal +4 response to the Bi-Digital O-Ring Test at these acupuncture points. Similar changes were also observed on acupuncture points CV17 (Shan Zhong), CV 22 (Tian Tu), Yin Tang (at an area just between the eyebrows: the pituitary gland representation area, colloquially known as the "third eye") and GV20(Bai Hui), the entire pericardium meridian & triple burner meridian, their acupuncture points, the adrenal glands, testes, ovaries and perineum, as well as along the entire spinal vertebrae, particularly on and above the 12th thoracic vertebra, medulla oblongata, pons, and the intestinal representation areas of the brain located just above and behind the upper ear. Using these findings as criteria for evaluating the effectiveness of reaching the Qi Gong state, we were able to reproduce during the experimental trials similar changes in ourselves and the patient being treated with therapeutic effects comparable to those of the Qi Gong Master. Beneficial effects of external Qi Gong treatment given by a Qi Gong practitioner 1 to 3 times for 10-20 seconds each (although most Qi Gong masters take 3-20 minutes per treatment) often resulted in improvement of circulation and lowering of high blood pressure, as well as relaxation of spastic muscles, relief of pain, and enhanced general well-being, all of which resemble acupuncture effects. In order to reproduce the same procedure with others, we selected 4 children ranging between 8 and 11 years of age who had no knowledge of Qi Gong or Oriental medicine. One of these four children, the 8 year old, was able to consistently reach the same Qi Gong state after less than a half day and another child, 11, after less than 2 days. Within a week, the other two were sometimes able to reproduce the Qi Gong state but not always. Using the Qi Gong state thus obtained, it was found that this type of Qi Gong energy is directed to specific directions from the hand and can even penetrate wooden or metal doors.(ABSTRACT TRUNCATED AT 400 WORDS)
Renal peripelvic multicystic lymphangiectasia is an unusual benign peripelvic fluid collection. The sonographic appearance, etiology, and differential diagnosis of peripelvic fluid collections are reviewed.
Acupuncture and Oriental meditation, particularly of Zen Buddhists have essential features in common. The physiological correlates of these features are discussed as they apply to therapy of psychosomatic disorders. Both acupuncture and meditation are characterized by alpha rhythms of the encephalograms, by relaxed wakefulness, by analgesia, by their pervasion of virtually the entire body. This set of correspondences is taken as sufficient to postulate that acupuncture induces a stillness with properties similar to those of the "quiet" of meditation. This induced deep relaxation may account for the vasolidation and increased vascular-capillary flow, intrinsic in acupuncture. Among the shared properties are the presence of low physiological noise-level and unresponsiveness to the aversive components of conditioned stimuli.
This is a review of 100 patients at our institution who were treated for superficial bladder cancer. In those patients with carcinoma in situ of the bladder who were treated with conventional therapy (resection and/or fulguration) and intravesical bacillus Calmette-Guerin (BCG) without intradermal BCG, and those patients who were treated with conventional therapy alone, we found a response rate of 60 per cent versus 40 per cent at the end of three months. In comparing those patients with superficial papillary cancer, we found a response of 39 per cent after conventional therapy and 63 per cent after conventional therapy and intravesical BCG. This suggests that intravesical BCG without intradermal BCG can be an important adjunct to the conventional therapy of bladder tumors.
The term: 'morning glory syndrome' is currently used to describe a clinical complex encompassing a primarily congenital, possibly hereditary optic nerve anomaly associated with other ocular and systemic abnormalities. This syndrome has been shown to be usually limited to the eye with non-involvement of the retrobulbar nerve and brain. However, recent studies have illustrated that morning glory syndrome may be associated with such systemic abnormalities as sphenoidal encephalocele. The authors present a review of the current literature and functionally analyze the incidence of retinal detachment, pre-retinal gliosis, increased production of fibrovascular tissue and other ocular abnormalities; as well as exploring the association of systemic involvement; utilizing fluorescein angiography, computerized tomography, ultrasonography and electrophysiology.
On the basis of reported results it is here postulated that acupuncture induces states of exceptionally low noise-level and that it shares essential features with the "quiet" of meditation. Noise, in the present context, can be represented by physiological interactions with factors that have no relevance to the nature of the essential physiological activities. These are "disturbed" by the noise. Decreasing relative noise-levels for a given signal are illustrated informationally by thermal noise in physics, chemistry, and physiological chemistry. Information, as noise decreases, becomes less diffuse and concurrently the perceived signals becomes sharper, more specific, and effectively more intense. Sharp differentiation becomes evident between formerly blurred signals. Weak signals ordinarily lost in the background become recognizable. Equivalent refinements in perception are cited by Zen Buddhist practitioners during and because of meditation. We are thus led to ascribe similar refinement during acupuncture to physiological activities, in particular, to those of the cerebral cortex. Thus, the processing and flow of physiological information have become more specific, sensitive, and comprehensive for regulation and for restoration to normal function.
Analogies in considerable detail hold between essential characteristics of classical conditioned defensive reflexes and immune reactions. The analogies become evident when combined conditioned and unconditioned stimuli are formally set into correspondence with combined hapten and carrier immunogens. Learning is elaborated also in the immune system when the transfer of information from the unconditioned to the conditional immuno-stimuli concurrently occurs. The analogies are regarded as having been evolved by adaptation of fundamentally parallel functions for survival against attack or invasion in the course of evolution, one on the macro- and the other on the micro- or molecular scale.
We describe a case of unilateral choroidal osteoma in a young white women referred to our office for evaluation of a possible malignant melanoma. The characteristic findings corresponding with other reported cases in the literature are a slightly elevated, yellow-white choroidal tumor lying in the posterior pole with the borders well defined; depigmentation of the pigment epithelium; and vascular tuft networks located on the tumor's surface. Our findings were characteristic of the previously observed choroidal osteoma results. Equator-plus photography was utilized for improved visualization of tumor size and activity. The pertinent clinical testing procedures aiding in the identification of this entity are presented.
The effect of flutamide, a potent nonsteroidal antiandrogen, on the metabolism of iv tracers of [3H]estradiol was studied in five patients with advanced prostate cancer. The drug produced no change in the percentage of the injected radioactivity recovered in urine or in the glucuronide or nonglucuronide conjugate fractions. Of the five individual metabolites that were quantitated, estrone, estradiol, and estriol were unaffected by flutamide, but the drug caused striking decreases in conversion of estradiol to 2-hydroxyestrone (4.0% vs. 7.4%) (P less than 0.005) and 2-methoxyestrone (1.1% vs. 2.6%; P less than 0.05); every one of the patients showed a marked fall in recovery of both of these compounds. This depression of the formation of 2-oxygenated metabolites is reminiscent of the findings in liver disease; the same abnormality occurs regularly in cirrhosis and frequently in extrahepatic biliary obstruction. Taken together with our previous studies of the effects of flutamide on testosterone and cortisol metabolism, this study demonstrates that flutamide produces multiple functional, reversible, cirrhosis-like disturbances of steroid metabolism. Because these disturbances are universal in the patients studied regardless of whether they had clinical responses to flutamide, we doubt that the steroid metabolic changes play a role in the therapeutic effect of the drug.
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Flutamide, a nonsteroidal antiandrogen, was given to 11 men with prostate cancer, in doses of 750 to 1500 mg daily for 0.5--7 months. Four patients had a clinical remission and seven showed no response. All the patients showed a profound change in the peripheral metabolism of testosterone: markedly increased conversion to androsterone (A) and correspondingly decreased conversion to etiocholanolone (E); the A/E ratio rose to levels never before observed consistently in any group of healthy or diseased humans. This change was probably due to alteration by flutamide of the relative activities of steroid 5alpha and 5beta reductase in favor of the former. 24-Hour mean plasma testosterone was increased in five of the six patients studied for this parameter, for the group as a whole, testosterone rose from 279 ng/dl to 484 ng/dl (P less than .05). 24-Hour mean values for plasma dihydrotestosterone, dehydroisoandrosterone, LH and FSH showed no significant change, for the group as a whole, in the same six patients. Since flutamide did not change the metabolic clearance rate or volume of distribution of testosterone tracers, the increased plasma levels of the hormone were probably due to increased production.