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Biomedical subjects

D Freeman

Publications and source records attributed to D Freeman.

At least 91 records · Page 5Linked to original sources
PubMed1987

Pediatric residents' assessment of adolescents' experiences during pelvic examination.

We compared male and female pediatric residents' perceptions of adolescent females' attitude and experience during a pelvic examination. Females (n = 112) ages 12-19 years were randomly assigned to a male of female examiner and to a supine or semisitting pelvic-examination position. Pre- and postexamination questionnaires were completed by the patients. Female physicians were more accurate in assessing patient discomfort (p less than 0.006),pain (p less than 0.0004), and embarrassment (p less than 0.0006) during the pelvic examination. The correlation between the physicians' and the patients' assessments of the completeness of the examination was stronger for the male physicians (p less than 0.003). These relationships remained constant for both positions. The female physicians' appeared to base their perceptions of the patient-physician relationship partly on the emotional responses of the patient such as embarrassment, fear, and relaxation (p less than 0.02). In contrast, male physicians' perceptions were associated with patient expressions of pain and discomfort (p less than 0.02).

Adolescent↗
PubMed1987

Vascular evaluation and treatment of the diabetic.

Vascular reconstruction in the diabetic is not recommended for the occasional vascular surgeon. In general, diabetics are higher operative risk patients and the majority are undergoing revascularization because of severe ischemia associated with a limb-threatening foot infection. The success of each of our series represents a team approach with careful preoperative screening and intraoperative monitoring as well as a meticulous and precise operative technique. The diabetic's predilection for distal arterial occlusive disease, more extensive calcification, and poor collateral formation require the maximum skill and experience of the operating surgeon. The results support a continued aggressive approach to revascularization of the ischemic diabetic extremity.

Aortic Diseases↗
PubMed1986

Effect of non-steroidal anti-inflammatory drugs on control of hypertension by beta-blockers and diuretics.

The effect of sulindac on renal function and blood pressure was compared with those of placebo, piroxicam, and naproxen in 20 patients with primary hypertension being treated with a diuretic and a beta-blocker. Although the three non-steroidal anti-inflammatory drugs (NSAIDs) did not differ in their effect on renal function (weight, glomerular filtration rate, creatinine clearance) or on serum thromboxane and plasma 6-keto prostaglandin F1 alpha (6-keto PGF1 alpha), blood pressure was significantly lower with sulindac than with placebo, piroxicam, or naproxen. These differences were associated with less renal cyclooxygenase inhibition by sulindac (reflected by urinary thromboxane B2 and 6-keto PGF1 alpha) than by other NSAIDs. The findings suggest that the blood pressure differences reflect vasodilation due to differences in the balance between systemic and renal effects of the NSAIDs.

6-Ketoprostaglandin F1 alpha↗
PubMed1986

Influence of position during examination, and sex of examiner on patient anxiety during pelvic examination.

It has been reported that adult women prefer the semi-sitting position over the supine position for the pelvic examination. We determined the effect of the pelvic examination position and the examiner's gender on adolescent anxiety with the pelvic examination. Adolescent girls (n = 112) aged 12 to 19 years were randomly assigned to a semi-sitting or supine position and to a male or female physician. Before and after the examination questionnaires containing the Spielberger State-Trait Anxiety Inventory and other scales were administered. There were no differences between the groups in pre-examination anxiety or concern. Patients in the semi-sitting group reported fewer negative responses during the examination when examined by a male physician (P less than or equal to 0.009); those in the supine group reported fewer negative responses when examined by a female physician. These findings persisted after controlling for previous pelvic examinations, frequency of sexual activity, and Tanner stage. Patients who had previously had a pelvic examination and were examined in the semi-sitting position by a male physician reported the lowest levels of post-examination anxiety (P less than or equal to 0.02). Patients who had never had a pelvic examination expressed less anxiety if they were examined in the semi-sitting position by a female physician. These data suggest that the patient's previous history of pelvic examinations and the gender of the examiner should be considered when selecting the pelvic examination position.

Adolescent↗
PubMed1986

Sjogren's syndrome in an adolescent.

Sjogren's syndrome is a chronic autoimmune disorder characterized by keratoconjunctivitis sicca, xerostomia, and recurrent enlargement of the salivary glands. Most commonly noted in adults, it rarely affects adolescents. We describe a 15-year-old adolescent with recurrent parotid enlargement as an initial manifestation of this disease.

Adolescent↗
PubMed1986

Contributions of nuclear magnetic resonance to renal biochemistry.

31P NMR as a descriptive technique is of interest to nephrologists. Particular contributions of 31P NMR to our understanding of renal function may be enumerated.: "Free" metabolite levels are different from those classically accepted; in particular, ADP and Pi are low with implications for the control of renal metabolism and Pi transport, and, via the phosphorylation potential, for Na+ transport. Renal pH is heterogeneous; between cortex, outer medulla, and papilla, and between cell and lumen, a large pH gradient exists. Also, quantitation between cytosol and mitochondrion of the pH gradient is now feasible. In acute renal failure of either ischemic or nonischemic origin, both ATP depletion and acidification of the renal cell result in damage, with increasing evidence for the importance of the latter. Measurements of renal metabolic rate in vivo suggest the existence of a prodromal phase of acute renal failure, which could lead to its detection at an earlier and possibly reversible stage. Human renal cancers show a unique 31P NMR spectrum and a very acidic environment. Cancer chemotherapy may alter this and detection of such changes with NMR offers a method of therapeutic monitoring with significance beyond nephrology. Renal cortex and medulla have a different T1 relaxation time, possibly due to differences in lipid composition. It seems that NMR spectroscopy has much to offer to the future understanding of the relationship between renal biochemistry and function.

Acute Kidney Injury↗
PubMed1984

Formation of n.m.r.-invisible ADP during renal ischaemia in rats.

Measurement of the adenine nucleotide and inorganic phosphate content of normoxic and ischaemic kidney in vivo has been made, comparing enzymic assay (after freeze-clamping and acid extraction) with quantification by 31P-n.m.r. Both methods give similar results for ATP, and n.m.r. quantification of Pi gives a value 25-50% of that obtained by enzymic assay. ADP, which is largely invisible to n.m.r. in the normoxic kidney, remains invisible during ischaemia despite a 2-3 fold rise in enzymically assayed ADP. N.m.r. and enzymic assay of the acid extracts give similar values for all metabolites measured. The question of ADP binding in the kidney is discussed, as are the implications for the metabolic regulation of ADP-dependent reactions.

Adenosine Diphosphate↗
PubMed1984

Monitoring response to chemotherapy of intact human tumours by 31P nuclear magnetic resonance.

10 kidneys bearing adenocarcinoma (hypernephroma), 1 ureteric tumour, 2 Wilms' tumour from patients undergoing nephrectomy, and normal human and animal kidneys were preserved and later tested to see whether normothermic blood perfusion restored glomerular filtration, oxygen consumption, and energy metabolism, as monitored by 31P nuclear magnetic resonance (NMR). NMR spectra of normal human kidney and of renal tumours were characteristic of kidney in other species (rat, rabbit, and dog), with six principal resonances assigned to adenosine monophosphate, inorganic phosphate (Pi), glycerophosphoryl choline, gamma, alpha, and beta adenosine triphosphate and an intrarenal pH 7.0-7.2. 7 out of 9 hypernephromas and 1 of the 2 Wilms' tumours produced an additional resonance at +4.2 ppm. This peak was absent from all normal kidney spectra and may represent Pi in a specific and highly acidic environment (pH 6.1-6.5) found in actively metabolising human tumours. Furthermore, in 1 tumour (out of 5 tested) the +4.2 ppm peak rose rapidly after the addition of chemotherapeutic agents to the perfusing blood. This observation may indicate drug sensitivity of this one tumour. The results suggest that 31P NMR imaging may be used to monitor therapeutic response during regional perfusion of malignant tumours in man.

Animals↗
PubMed1984

Pneumothorax in an adolescent with fulminant systemic lupus erythematosus.

Pneumothoraces and pneumohemathoraces have been described in adults with systemic lupus erythematosus (SLE). Although a spectrum of pulmonary involvement has been associated with SLE in childhood and adolescence, recurrent pneumothoraces have not been reported. We describe a case of a 13-year-old adolescent with fulminant SLE and a recurrent left pneumothorax.

Adolescent↗
PubMed1984

Pharmacokinetics of the major metabolites of D-penicillamine in patients with rheumatoid arthritis.

The pharmacokinetic disposition of D-penicillamine and its major metabolites, penicillamine cysteine disulfide ( PSSC ) and penicillamine disulfide ( PSSP ) has been studied in eight patients with rheumatoid arthritis. Plasma concentrations of D-penicillamine, PSSP and PSSC displayed similar characteristics in terms of times to maximum concentrations and biphasic elimination from plasma. Initial t1/2 (alpha) phase ranged from 0.86 to 4.41 h for parent drug and 0.81 to 4.41 h for metabolites. Final t1/2 (beta phase) ranged from 3.4 to 9.45 h for D-penicillamine and 5.62 to 21.7 h for the metabolites. Total drug and metabolites detected in urine accounted for 12.0 to 48.7% of oral drug.

Adult↗
PubMed1983

Energetics of sodium transport in the kidney. Saturation transfer 31P-NMR.

31P-NMR has been used to quantify inorganic phosphate (Pi) and high-energy phosphates in the isolated, functioning perfused rat kidney, while monitoring oxygen consumption, glomerular filtration rate and sodium reabsorption. Compared with enzymatic analysis, 100% of ATP, but only 25% of ADP and 27% of Pi are visible to NMR. This is indicative that a large proportion of both ADP and Pi are bound in the intact kidney. NMR is measuring free, and therefore probably cytosolic concentrations of these metabolites. ATP synthesis rate, measured by saturation transfer NMR shows the P:O ratio of 2.45 for the intact kidney. This is close to the theoretical value, suggesting the NMR visible pool is that which is involved in oxidative phosphorylation. The energy cost of Na transport, calculated from the theoretical Na:ATP of 3.0 exceeded the measured rate of ATP synthesis. Instead, Na:ATP for active transport in the perfused kidney was 12. Since the phosphorylation potential ( [ATP]/[ADP]X[Pi] ) by NMR was 10 000 M-1, the free-energy of ATP hydrolysis was 52 kJ/mol. Using this figure, the rate of ATP hydrolysis observed could fully account for the observed rate of sodium reabsorption.

Adenine Nucleotides↗
PubMed1983

Conversion in vitro of urinary (+)-penicillamine to its major metabolites, PSSP and PSSC.

To investigate the discrepancy between the apparent pharmacokinetic disposition of (+)-penicillamine in plasma and urine, the spontaneous degradation of (+)-penicillamine was studied in acidified and non-acidified urine. Degradation was prevented by acidification. The oxidized metabolites were converted to reduced (+)-penicillamine by electrolysis.

Biotransformation↗