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Biomedical subjects

H P Freeman

Publications and source records attributed to H P Freeman.

At least 37 records · Page 2Linked to original sources
PubMed1989

Cancer of the breast in poor black women.

The authors carried out a retrospective analysis of 708 patients (94% blacks) with breast cancer who were diagnosed, treated and/or followed at Harlem Hospital Center (New York) between 1964 and 1986: nearly all patients were of low economic status with almost 50% having no medical coverage. Surgical treatment was implemented in 512 patients (72%). Radiotherapy and/or chemotherapy alone were used in 94 patients (13%); 102 patients (14%) refused treatment or died before its initiation. The 5-year and 10-year survival rates for those treated surgically were 39% and 27%, respectively. For those patients undergoing surgery (47% of whom were in Stages III and IV), 5-year and 10-year survival rates were analyzed according to stage of the disease. They were 54% and 54%, respectively, for Stage I; 56% and 35%, respectively, for Stage II; 41% and 18%, respectively, for Stage III; and 11% and 0%, respectively, for Stage IV. There was significant difference in the 5-year survival rates between patients with pathologically negative lymph nodes (64%) and a single positive lymph node (71%), compared to those with multiple positive lymph nodes (33%; P = 0.001). The 10-year survival rates were 39%, 34%, and 15% (P = 0.001), respectively. The authors conclude that breast cancer survival in this population of poor black women is low compared to the survival rate of black women nationally and very low compared to white women.

Adult↗
PubMed1989

Macromolecules reduce abnormal microvascular permeability in rat limb ischemia-reperfusion injury.

We studied the effect of iv administration of biodegradable macromolecules on microvascular permeability after ischemia-reperfusion injury in a rat gastrocnemius model. After 2 h of tourniquet ischemia of the rats' hind limb, groups of animals were given iv lactated Ringer's solution (RL), serum albumin 5%, or varying MW fractions of biodegradable macromolecules of hydroxyethyl starch (HES), glycogen, and dextran. At the conclusion of the 24-h reperfusion period, the rat gastrocnemius muscles were collected. Water and K+ differences between the ischemic and control muscles were compared. Rats given a 100,000 to 300,000-dalton fraction of HES had significantly decreased water content (5.1 +/- 3.4%) when compared to rats receiving RL (8.3 +/- 2.2, p less than .01), less than 100,000 dalton HES (8.3 +/- 3.2, p less than .05), less than 300,000 glycogen (7.9 +/- 2.5, p less than .01), or dextran 150,000 (8.3 +/- 1.5, p less than .05). Rats given 100,000 to 300,000-dalton HES also had significantly higher ischemic muscle K+ content as compared to the nontourniquet control (difference 14.2 +/- 9.7 mEq/g) than rats receiving any of the other solutions (range 32.5 to 39.3) except the 300,000 to 1,000,000-dalton fraction of HES. Regression analysis comparison of K+ difference to the histologic evaluation of the muscles on the criteria of polymorphonuclear infiltration and interstitial edema (0, best; 3, worst) had a Pearson correlation coefficient of r = .73. Reduction of abnormally increased microvascular permeability may be accomplished by the iv use of appropriate sized biodegradable macromolecules.

Animals↗
PubMed1989

A biophysical approach to capillary permeability.

In this preliminary report, the capillary leakage that occurs after scald injury is considered a biophysical phenomenon and is treated by sealing the "pores," or endothelial gaps, in the capillary membranes with biodegradable macromolecules of the appropriate size and shape. We have measured albumin leakage from standardized scald burns in the rat jejunum with and without variously sized fractions of intravenous macromolecules of hydroxyethyl starch (HES) used as a sealing agent. The observed reduction of albumin leakage from injured capillaries was attributed to the sealing effect. The fraction HES (Fm) with molecular weights of 100,000 to 300,000 daltons performed significantly better (p less than 0.05) as a sealing agent when compared with HES (F1) fraction molecular weights of 300,000 to 3.4 million daltons, HES (Fs) molecular weight less than 50,000 daltons, and two control groups receiving the intravenous Ringer's lactate solution or serum albumin 5%. This capillary sealing phenomenon was shown to be independent of colloid osmotic pressure effect. It is believed to be related to the size and the shape of the noncharged macromolecules.

Animals↗
PubMed1988

Management of stab wounds to the thoracoabdominal region. A clinical approach.

We studied 324 patients admitted to Harlem Hospital Center from July 1981 to June 1986 with stab wounds of the thoracoabdominal region (area limited by a coronal circle through the fifth interspaces anteriorly and seventh interspaces posteriorly from above to a subcostal circle 5 cm caudad to the costal margins and 12th ribs from below). We divided this region into 12 zones (six symmetrical zones on each side) using the above upper and lower limits and the costal margins, the midlines, and the anterior and posterior axillary lines. This study was conducted to determine the incidence of transdiaphragmatic penetration for the thoracoabdominal region stab wounds in each of the 12 zones identified for the first time and applied in this study, and the reliability and safety of surgical management based mainly on physical examination. The highest incidence of transdiaphragmatic penetration occurred in stab wounds of the left anterior lower thoracic zone (21.7%). The lowest incidence was 0% and the overall incidence was 11%. Physical examination was accurate in making the diagnosis in 95.4% of all cases and no mortality was associated with a delay in diagnosis that may have resulted from the serial physical examinations. We conclude that this method of selective operative management based on physical examinations is accurate and safe.

Abdominal Injuries↗
PubMed1987

Localization and retrieval of bullets under ultrasound guidance.

From May 1985 to February 1986, high-frequency B-mode real-time ultrasound examinations proved helpful in localizing bullets that were not palpable externally in the extremities and body wall of six patients. Of these, four patients had bullets removed successfully with the ultrasonically guided needle puncture technique. The entire procedure was carried out independently at the bedside by the surgical team. We further concluded that surgeons would benefit by learning and using ultrasound, a technique that is relatively easy to acquire and that has broad potential for surgical application, especially in the operating room.

Adolescent↗
PubMed1987

Extended applications of ultrasonography by the surgeon. A preliminary report.

The application of ultrasonography by surgeons in hospitalized patients and the potential benefits thereof were evaluated in 52 patients. Ultrasonography was used to diagnose emergent conditions in 30 patients, nonemergent conditions in 16 patients, and as a guide for interventional procedures in 6 patients. The procedure was carried out by a specially trained member of the surgical team, thus providing use of the technique as required. In assessing the degree of reliability of ultrasonography for surgical decision-making, it was found to be helpful in arriving at a decision in 47 patients, not helpful in 3 patients, and misleading in 2 patients in whom results were misinterpreted. The use of ultrasonography by the surgical team may help to provide early diagnosis, and thus may shorten the delay in necessary surgical intervention. It can also serve as a guide during interventional procedures and thereby can increase their safety and accuracy. We believe that the ability to carry out and interpret ultrasonographic tests is a helpful addition to the surgeon's armamentarium.

Adolescent↗
PubMed1987

Thrombosis of noncatheterized internal jugular vein: a unique complication of subclavian catheterization diagnosed by ultrasound.

Using portable high-resolution real-time B-mode ultrasound, the authors observed the phenomenon of thrombosed internal jugular vein in four patients who had prolonged indwelling ipsilateral subclavian catheters with or without catheterized subclavian vein thrombosis. Of these, thrombosed internal jugular vein was found incidentally in three patients with no specific findings suggestive of this complication.The origin of this uncommon complication is thought to be flow stasis in the internal jugular vein due to multiple factors associated particularly with turbulence at the jugulo-subclavian junction and the effect of hyperosmolar solution on blood cells. Treatment consists of removal of the catheters and heparinization when indicated. The authors recommend high-resolution ultrasound in the detection and follow-up of this unusual complication.

Aged↗
PubMed1986

Acute soft tissue infection in intravenous drug abusers: its differential diagnosis by ultrasonography.

Portable, real-time, B-mode ultrasonography was used by surgeons to diagnose acute soft tissue infections in intravenous drug abusers. It was helpful in differentiating simple cellulitis from abscess and in detecting pseudoaneurysm and thrombophlebitis. The authors conclude that ultrasonography as an initial diagnostic method for these types of lesions provides both early diagnosis and early treatment, thereby shortening hospital stay and reducing complications.

Abscess↗
PubMed1985

Penetrating neck wounds. Mandatory versus selective exploration.

We reviewed the records of 257 patients (ages, 16-83 years) with penetrating neck wounds (119 gunshot and 138 stab) managed at Harlem Hospital Center. Among the first 148 patients, 134 were managed by mandatory neck exploration; 42 had injuries (31%), and 92 (69%) had no injury. There were four deaths (3%) and seven (5%) morbidities. Because of the high rate of unnecessary operations, the following 109 patients were managed selectively, 40 by exploration, and nine of the 40 (22%) had no injury; 69 were observed and did not require subsequent operative intervention. There were six deaths (5.5%) and six morbidities (5.5%) among the second group. Morbidity and mortality were unrelated to the method of management but related to the type and severity of injuries, associated injuries, preexisting illnesses, and age of the patients. The frequency of operations for penetrating neck wounds without structural injuries was minimized in the selective exploration group.

Adolescent↗
PubMed1981

Necrotizing fasciitis.

Fourteen patients with necrotizing fasciitis seen over a 5 year period at a public hospital are reviewed. Middleaged men predominated. The disease followed such diverse initiating causes as self-injection with heroin, boil, ischiorectal abscess, perforated occult colonic cancer and trivial abrasions. In a few cases there was no evidence of an initiating lesion. Necrotizing fasciitis affected the arms, legs, trunk and neck. Bacteriologic analysis showed that the disease is usually caused by gram-negative bacilli and hemolytic streptococci, alone or in combination. Morbidity and mortality rates in the present series were influenced by associated clinical conditions such as old age, diabetes mellitus, carcinoma and gram-negative bacteremia.

Adult↗
PubMed1980

Demonstration of traumatic pleuro-biliary fistula with 131I-rose bengal.

Penetrating thoracic trauma may result occasionally in communication between the pleura and biliary tree. A case of traumatic pleurobiliary fistula secondary to stab wound of the right chest was demonstrated with (131)I-rose bengal scan. The diagnosis was made 15 days after trauma and was managed conservatively with a thoracostomy tube drainage.

Adult↗
PubMed1979

Unusual presentations of carcinoma of the right colon.

Two unusual presentations of carcinoma of the right colon are described. One of the two patients presented with a right gluteal abscess and the other presented with a colocutaneous fistula to the anterior abdominal wall at the site of a previous appendectomy scar. Despite extensive local tumor invasion of adjacent structures in both cases, all the regional lymph nodes were free of cancer and the tumors were of low-grade malignancy. A review of the literature indicates that bulky colonic tumors with extensive local invasion and negative mesenteric lymph nodes have a relatively good prognosis if adequate resection is performed.

Abdominal Muscles↗
PubMed1979

Analysis of benign breast lesions in blacks.

A clinicopathologic analysis of 202 benign breast lesions in black women is presented. The study shows that the peak incidence of fibroadenoma occurs at an earlier age in black than in white patients. Fibrocystic disease is most frequent in both black and white patients between 25 and 45 years of age. It is noteworthy that nulliparous adolescent blacks have a higher risk of fibroadenoma developing and our findings confirm the observation made by Funderburk et al [5] and Nigro and Organ [6] that the incidence of fibroadenoma in blacks is high. The low incidence of fibrocystic disease in our patients does not reflect the clinical incidence of the disease because most patients with fibrocystic disease do not undergo biopsy. We are unable to draw any conclusions about the relation between the use of oral contraceptives and the incidence of benign breast disease. In conclusion, a review of the literature and an analysis of our data suggest a relatively higher incidence of fibroadenoma among black patients. In contrast to the finding in the white population, it appears that in blacks fibroadenoma is more common than carcinoma of the breast.

Adenofibroma↗