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Biomedical subjects

J M Freeman

Publications and source records attributed to J M Freeman.

At least 91 records · Page 5Linked to original sources
PubMed1985

Status epilepticus.

Status epilepticus is a serious medical emergency requiring immediate and rational therapy. Rapid initial management is directed at stabilization of vital functions and a quick but thorough assessment of clinical and laboratory studies to determine etiologies. Initial drug management is directed at the rapid control of status with prevention of recurrence by sustaining a therapeutic level of a long acting anticonvulsant. Few patients should remain in status more than 30 minutes after initiation of therapy.

Anesthesia, General↗
PubMed1984

The effects of stimulus and subject factors on a face matching task.

An initial experiment revealed that, under very rapid viewing conditions, the usual asymmetry for face recognition occurred only for low-detail facial sketches. Photographs and medium-detail sketches failed to show VF asymmetry. A further experiment revealed that the effect was unlikely to be attributable to discrimination difficulties; this experiment, however, replicated the LVF superiority on low-detail faces only for male subjects. These results are briefly examined in the light of Sergent's theoretical interpretation of hemisphere asymmetry (Sergent, J. Percept. Psychophys. 31, 451-461, 1982). They are also discussed in relation to sex differences in cerebral asymmetry.

Adult↗
PubMed1984

Epilepsy and the inner city schools: a school-based program that makes a difference.

A program was developed within the Baltimore City School System to comply with U.S. Public Laws 94-142 and 94-484. The program provided assessment, appropriate placement, counseling, work experience, and epilepsy education. Self-identified students were primarily black and poor, more likely to be either 1 year behind in reading or in special education. Seventy percent had psychosocial problems but for less than half were the problems directly related to seizures. The program decreased the nonpromotion rate and the dropout rate to less than half of that for the school system as a whole, and cut in half the percentage of youths who were unemployed or not in school or training 1 and 2 years after graduation. The per pupil cost was 10% greater than current expenditures for the system as a whole.

Adolescent↗
PubMed1984

Pneumocystis carinii antigenemia in adults with malignancy, infection, or pulmonary disease.

A counterimmunoelectrophoresis test for Pneumocystis carinii antigenemia was employed to assess the extent of subclinical infection or colonization with this agent in adults with infection, pulmonary disease, or malignancy and in healthy homosexual men. Antigenemia was detected in 6 of 208 (3%) of normal controls, 3 of 28 (11%) of patients with pulmonary infection, 3 of 33 (9%) of those with chronic lung disease, 1 of 36 (3%) of patients with lung cancer, 7 of 271 (3%) of afebrile subjects with malignancy, 6 of 19 (32%) of febrile patients with malignancy, 2 of 22 (9%) of those with nonpulmonary infection, and 0 of 21 (0%) of healthy young homosexual men. These data suggest that P. carinii is a common commensal or saprophyte that becomes clinically significant only when host defenses are impaired. Antigenemia may occur intermittently during various disease states in the absence of positive clinical signs and should alert the physician to subacute infection or colonization. Treatment appears advisable when clinical data and counterimmunoelectrophoresis results concur.

Antigens, Protozoan↗
PubMed1983

Anticonvulsant serum levels are useful only if the physician appropriately uses them: an assessment of the impact of providing serum level data to physicians.

The ability to measure serum levels of anticonvulsants has been a significant advance in the treatment of epilepsy. This technique enables practitioners to monitor a patient's plasma concentration, to detect potential toxicity, and to assess compliance with the prescribed regimen. A retrospective study of 164 adults with epilepsy was conducted to evaluate how serum anticonvulsant determinations were used by physicians in their treatment of epilepsy. Results indicate that the availability of test results did not improve the degree of seizure control, nor did it diminish patient reports of toxicity. In 17% of therapeutic decisions, prescribers did not appear to use the blood levels appropriately in their therapeutic decision-making process. When physicians did appropriately utilize information from serum levels, the degree of seizure control improved significantly compared with when the prescribers did not use this information. The cost of determining serum levels of anticonvulsants is justified only if the information is appropriately utilized.

Anticonvulsants↗
PubMed1983

Long-term outcome of children with severe head trauma and prolonged coma.

Forty-six children with significant head trauma who remained in coma more than 24 hours were the subjects of this long-term outcome study. Twelve (38%) died. The average length of coma in the 34 survivors was 15.5 days. Follow-up ranged from 9 months to 4 years (mean 21 months). Twenty-nine percent of the survivors were normal at follow-up. An additional 53% had mild cognitive or behavioral problems, but 61% of these had evidence of similar problems prior to the injury. Nine percent of survivors had motor residua but normal intellect. Nine percent had severe intellectual and motor problems. Children less than 2 years of age had a worse outcome. Despite severe injury and prolonged coma after head trauma, most children do well. Intensive medical and surgical care increases the rate of survival and does not result in a large number of severely disabled survivors.

Adolescent↗
PubMed1982

The growth of segmental nerves from the spinal cord to the hind limb-bud in the axolotl.

It has been concluded from previous experiments involving the growth of segmental nerves from the amphibian spinal cord to the limb-bud that axons are attracted to the limb-bud region by their target tissue (Hamburger, 1929; Hughes and Tschumi, 1958). In the present study this hypothesis has been tested by obstructing the pathways over which the nerves normally grow. It was found that for those nerves which marginally obstructed far fewer axons were able to reach their target. The spinal ganglia associated with these nerves contained up to 50% fewer cells than the adjacent unobstructed segmental level. These results suggest that nerves are not attracted from the spinal cord by the target tissue, but rather that the pathways provided by the axial segmental nerves are essential if a normal number of axons are to reach their target.

Ambystoma mexicanum↗
PubMed1982

Neonatal seizures. I. Correlation of prenatal and perinatal events with outcomes.

A review of 277 newborns with neonatal seizures enrolled in the Collaborative Perinatal Project revealed a mortality of 34.8%. Of the 181 survivors, most followed up to age 7 years, 70% were normal. Thus, despite the fact that seizures are a major indicator of perinatal asphyxia and a predictor of subsequent neurologic deficit, most infants with neonatal seizures who survived did well. Thirteen percent had cerebral palsy, 19% had an IQ less than 70, and 20% had epilepsy. Thirteen percent of survivors had a combination of mental retardation, cerebral palsy, or epilepsy. A low Apgar score, the need for resuscitation after 5 minutes of age, low birth weight, and the early onset of seizures or prolonged seizures correlated with adverse outcome.

Apgar Score↗
PubMed1982

Neonatal seizures. II. A multivariate analysis of factors associated with outcome.

A multivariate analysis of perinatal events occurring in infants with neonatal seizures who were enrolled in the National Collaborative Perinatal Project allowed prediction of outcome. This prediction of death or of mental retardation, cerebral palsy, or epilepsy was empirically confirmed 64% to 83% of the time. In an infant with neonatal seizures, a five-minute Apgar score of less than 7, the need for resuscitation after 5 minutes of age, the onset time of the seizures, and a seizure lasting more than 30 minutes are the best early predictors of which infants will die or will have significant neurologic sequelae. It is hypothesized that neonatal seizures may be a better indicator of the severity or duration of intrauterine asphyxia than the Apgar score. In the neonate with seizures, the use of the formula may allow identification of infants at high risk for adverse outcomes.

Apgar Score↗
PubMed1982

A new, treatable source of recurrent meningitis: basioccipital meningocele.

A 19-month-old boy suffered eight episodes of bacterial meningitis. During the ninth episode a meningocele of the basioccipital clivus communicating with the nasopharynx was discovered. Identification of the organism causing the episodes of meningitis was not helpful in pointing to the site of this congenital anatomic defect. Surgical closure of the defect has prevented further recurrences.

Humans↗
PubMed1981

Stopping medication in children with epilepsy: predictors of outcome.

Anticonvulsant therapy was discontinued in 68 children with epilepsy who had had no seizures for four years, in an attempt to find the risk of relapse and the factors predictive of recurrence. In this population the probability of remaining free of seizures for four years after discontinuation of medication was 69 per cent. Children were more likely to have recurrent seizures if they were mentally retarded, if their seizures had begun before two years of age, if they had had many generalized seizures before control, or if they had had a definitely abnormal electroencephalogram before medication was discontinued. Multivariate analysis showed that the best predictors of outcome were the electroencephalogram taken at cessation of medication and the number of seizures before control. We conclude that in the normal child who has not had many seizures and whose electroencephalogram is normal or mildly abnormal, the risks of discontinuing medication after four seizure-free years are acceptable.

Adolescent↗