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Biomedical subjects

L Freedman

Publications and source records attributed to L Freedman.

At least 19 recordsLinked to original sources
PubMed1995

High dose rate endobronchial brachytherapy in the management of primary and recurrent bronchogenic malignancies.

BACKGROUND: The clinical, radiographic, and bronchoscopic records of patients treated with out-patient high dose rate (HDR) endobronchial brachytherapy were reviewed to determine its effectiveness in patients with malignant airway obstruction (with or without prior external beam radiation). In addition, quality of life and acute and chronic morbidity were evaluated. METHODS: From January 1, 1989 to June 30, 1993, 46 patients received 128 HDR endobronchial treatments employing a high activity Ir-192 source with a remote afterloader. Patients treated had a total of 22 primary and 17 recurrent bronchogenic carcinomas, 7 of which were metastatic nonpulmonary tumors. Three separate fractions of 7.0 Gy were prescribed to a depth of 1.0 cm. and given 1 week apart. Twelve patients (30%) received prior external beam irradiation (median dose, 58 Gy). RESULTS: Median follow-up for the entire group was 5 months (17.5 for surviving patients). Of the eight asymptomatic patients, five (62%) remained asymptomatic for the remainder of their lives. Of the 38 symptomatic patients, 28 (74%) had significant clinical improvement, and 12 of them remained improved for the duration of their lives. Of thirty-six (78%) patients examined for radiographic response, 25 (69%) had a partial or complete response to this treatment. In patients without prior irradiation, there was a tendency for a higher percentage of clinical and radiographic response. Two patients (4%) experienced mild, transient dysphagia, four patients developed self-limited radiation pneumonitis (9%), and three patients (7%) suffered fatal hemoptysis (all of these patients received prior or concurrent external beam radiotherapy). No factor (i.e., prior radiation therapy, number of catheters placed, surgery, or chemotherapy) predicted an increased risk of complications (P = NS). CONCLUSIONS: Outpatient HDR endobronchial brachytherapy is effective in both preventing and relieving endobronchial obstruction in patients with or without prior irradiation, recurrent lesions, or metastatic nonpulmonary disease. A significant proportion of patients can be rendered asymptomatic for the duration of their lives, hence were provided with improved quality of life. These treatments are well tolerated and safe, and result in minimal long term morbidity.

Aged↗
PubMed1992

Temporal patterns of agitated nursing home residents.

Twenty-four highly agitated, cognitively impaired nursing home residents were studied in depth to determine whether they manifested temporal patterns of agitation. Results demonstrated that agitated behaviors were significantly associated with temporal factors. For instance, residents made more requests for attention during lunch than other time periods, and residents screamed most often during the night. Some agitated behaviors (e.g., aggression) were manifested more frequently in the evening than in the day, consistent with the notion of sundowning in the nursing home. Implications of temporal patterns of agitation for caregivers of severely cognitively impaired and agitated nursing home residents are discussed.

Aged↗
PubMed1992

Pure alexia and right hemiachromatopsia in posterior dementia.

A 66 year old, right handed woman presented with pure alexia and right hemiachromatopsia (PARH) in the context of a posterior dementia. PARH was accompanied by prosopagnosia, 2-D object agnosia, and environmental agnosia. Visual fields were normal to confrontation testing. The pathological anatomy of PARH involves circumscribed damage to the lingual and fusiform gyri and paraventricular white matter of the left occipital cortex, two contiguous cortical regions functionally specialised for processing colour and word form information, respectively.

Aged↗
PubMed1991

Endocranial capacity of Western Australian aboriginal crania: comparisons and association with stature and latitude.

The endocranial capacities (ECCs) of 73 Western Australian Aboriginal crania were estimated. Using water-standardised mustard seed, ECCs were (in cm3) males--means 1,239, S.D. 92.3; females--means 1,118, S.D. 77.5. The male and female mean values were smaller than those previously published for Australia as a whole; sexual dimorphism (9.7%) was also slightly lower. Comparison of the Western Australian Aboriginal sample with a large Danish sample (Pakkenberg and Voigt, 1964; Holloway, 1980) permitted analysis of factors underlying sex and population differences in ECC. In both samples about 40% of the mean sex differences in ECC could be related to stature differences; for each sex almost 2/3 of the differences between the Western Australian and Danish means appear to be associated with differences in stature and latitude. Allometric adjustments are also involved.

Body Height↗
PubMed1991

Visuospatial ability in cortical dementia.

The level and pattern of visuospatial ability were comparatively examined in patients with putative cortical dementia (CD) and acute right hemisphere (RH) injury. Visuospatial ability was evaluated using measures of block construction, spatial reasoning, hemispatial search, and visuoconstructive copy. The incidence of neglect was also determined using special index measures derived from the spatial tasks. There was no difference between the CD and RH groups on measures of block construction, visuoconstructive copy, and spatial reasoning. While the overall incidence and severity of neglect was generally equivalent between the two clinical groups, 50% of the CD patients exhibited a pattern of right spatial neglect. In addition, a strong relationship was not evident between neglect laterality in CD and corresponding asymmetric cognitive and sensory-perceptual compromise, suggesting that neglect in CD may be due to different mechanisms than those causing neglect following right hemisphere injury. The findings indicate that while patients with putative CD perform like individuals with recent right hemisphere injury with respect to mean level of visuospatial ability, many exhibit a differential pattern of compromise related to the laterality of visuospatial neglect. The relevance of these results for the clinical diagnosis of CD is discussed.

Analysis of Variance↗
PubMed1991

Two studies of pacing in the nursing home.

Two studies concerning pacing by nursing home residents are presented. The first was a cross-sectional survey of 402 residents, which found that 39% of the subjects were pacers. In comparison to residents who did not pace, the pacers had fewer medical diagnoses, better appetites, and had resided in the facility for fewer years. Additionally, pacing was positively related to cognitive impairment and to past life-threatening experiences. Results of the second study, an observational study of six cognitively impaired residents who paced frequently, showed that these residents paced more when the environmental conditions were conducive to pacing (e.g., adequate lighting, enough room within which to pace). We believe that pacing is a reflection of good health within the nursing home population and suggest that caregivers may want to encourage rather than inhibit this behavior in some nursing home residents.

Activities of Daily Living↗
PubMed1991

Posterior cortical dementia with alexia: neurobehavioural, MRI, and PET findings.

A progressive disorder of relatively focal but asymmetric biposterior dysfunction is described in a 54 year old right handed male. Initial clinical features included letter-by-letter alexia, visual anomia, acalculia, mild agraphia, constructional apraxia, and visuospatial compromise. Serial testing demonstrated relentless deterioration with additional development of transcortical sensory aphasia, Gerstmann's tetrad, and severe visuoperceptual impairment. Amnesia was not an early clinical feature. Judgment, personality, insight, and awareness remained preserved throughout most of the clinical course. Extinction in the right visual field to bilateral stimulation was the sole neurological abnormality. Early CT was normal and late MRI showed asymmetrical bioccipitoparietal atrophy with greater involvement of the left hemisphere. Results from positron emission tomography (PET) showed bilaterally asymmetric (left greater than right) occipitotemporoparietal hypometabolism. The metabolic decrement was strikingly asymmetric with a 50% reduction in glucose consumption confined to the left occipital cortex. The picture of occipitotemporoparietal compromise verified by MRI, PET, and neurobehavioural testing would be unusual for such degenerative dementias as Alzheimer's (AD) and Pick's disease, although atypical AD with predominant occipital lobe involvement cannot be excluded. This case supports the concepts of posterior cortical dementia (PCD) as a clinically distinct entity and for the first time documents its corresponding metabolic deficit using PET.

Atrophy↗
PubMed1989

Using permutation tests and bootstrap confidence limits to analyze repeated events data from clinical trials.

In clinical trials comparing treatments for superficial bladder cancer, patients are at risk of repeated recurrences of their disease. Statistical methods of analyzing such data are required. This article presents a nonparametric approach. A statistical test to compare the recurrence or tumor rates in two treatment groups, using the randomization distribution, is described. Confidence intervals for the rate ratio are determined from the bootstrap distribution. The implementation of both requires Monte Carlo methods. Computer simulations support the use of these nonparametric methods when there are more than 60 recurrences in each treatment group. An example illustrating their use is given. The strategy adopted for analysis of these data could be applied to other clinical trials where standard methodology is inappropriate.

Biometry↗
PubMed1988

Beneficial effect of heparin in the management of patients with APL.

115 patients with acute promyelocytic leukaemia (APL) were studied retrospectively to evaluate prognostic factors and assess therapeutic approaches, particularly the use of heparin in the management of disseminated intravascular coagulation (DIC). The remission rate was 86% (30/35 patients) in those who received heparin and 49% (39/80 patients) in those who received no heparin (P = 0.0002). This difference in remission rates was accounted for by a marked decrease in the number of haemorrhagic deaths, especially those due to intracranial haemorrhage (ICH), in the heparin treated group. Other factors associated with a poor remission rate were prothrombin ratio (PTR) greater than 1.3 (P = 0.008), fibrinogen less than 1.5 g/l (P = 0.02) and WCC greater than 2.0 x 10(9)/l (P = 0.03).

Acute Disease↗
PubMed1988

Allograft versus autograft bone in scoliosis surgery.

The results of a study of the use of autograft versus allograft bone in the surgery of idiopathic adolescent scoliosis are presented. Two groups of patients, matched for age, sex, level and angle of curve, received bone grafts, 20 patients having autogenous bone from the iliac crest and the other 20 having donor bone from a bone bank. Both groups had otherwise identical posterior fusions and Harrington instrumentation. There was no difference between the two groups in a blind, radiographic assessment of bone graft mass at six months, nor in maintenance of the curve correction over the same period. No major operative complications nor failures of instrumentation were encountered. There was, however, a marked reduction in operative time and blood loss in the patients receiving donor bone and also a much lower incidence of late symptoms relating to the operative sites. We conclude that, even in the presence of adequate iliac crest, the use of bank bone is superior for grafting in idiopathic scoliosis surgery.

Adolescent↗
PubMed1988

The management of congenital dislocation of the hip in the newborn.

We describe the results of a policy of highly selective splintage for CDH, using knee plasters. No child suffered because splintage was withheld. In those who were treated the results were satisfactory and the proportion who required a subsequent operation was extremely low. Avascular necrosis was not a significant problem. The method, although a little more time consuming, appears to offer significant advantages over current alternatives.

Hip Dislocation, Congenital↗
PubMed1988

Diagnosis and management of intestinal endometriosis. A report of five cases.

Five cases of intestinal endometriosis presented with infertility and pelvic pain. Rectal bleeding occurred in two patients and diarrhea in one. A diagnosis was achieved with a barium enema study and colonoscopy. All the patients had pelvic endometriosis as documented by laparoscopy. Endometriosis was present in the sigmoid colon in three patients and in the cecum in one; it was pericecal in the fifth. Bowel resection and pathologic study are necessary to relieve the symptoms and avoid neglecting a malignant tumor or other lesions.

Adult↗
PubMed1987

State of the art in comparative cancer clinical trials.

In order to investigate the current state of the art in clinical cancer research, a survey of comparative cancer clinical trials was conducted using a MEDLINE literature search of the 6-month interval from July to December of 1985. Data were obtained primarily from the published abstracts. The major observations from the study are as follows. First, trials in cancer research are published in an extraordinarily wide range of journals covering most of the major medical specialties in addition to the many cancer specialty journals. Second, randomization is now used quite extensively. It is the predominant method of control in chemotherapy trials and in trials reported in cancer journals. However, its use is much less common in other specialties, especially surgery, so efforts to popularize randomization in these specialties would be beneficial. Third, sample sizes are highly variable, and the median sample size (96 patients) is too small to reliably detect and evaluate moderate treatment advances. Finally, our survey reveals that published trials show an inordinately large proportion of breakthroughs in treatment compared with the generally accepted view that only slow progress is being made in developing effective cancer treatments. Our view is that this result reflects the strong tendency to publish only studies with positive results. This hypothesis is supported by the fact that in nonrandom trials there tend to be more positive conclusions and an absence of a strong association between conclusions and sample size.

Clinical Trials as Topic↗
PubMed1986

The application of flow cytophotometry in measurements of cell adhesion.

A common approach to the study of cell substrate interactions is the measurement of the attachment of cells to different substrates or to cultured cell layers. The evaluation of attachment is made either by scintillation counting of previously labelled adhering cells, or by light microscopy using the criterion of cell shape, sometimes refined by automatic image analysis. These methods have many drawbacks. This paper suggests the use of fluorescence-activated flow cytophotometry, (FC) which yields direct counts of the non-adhering cells. These "free" cells are removed after completion of the adhesion experiment from the microtitre plate wells. An internal standard, in the form of fluorescent polystyrene beads is added, allowing evaluation of the percentage of cells adhering to the well walls. Flow cytophotometry then produces data based on the analysis of large populations of cells. Unequivocal discrimination is obtained between the counted cells and counted fluorescent beads eliminating counting errors. The results can be processed on line by computer. A suspension of mouse splenocytes was used for the evaluation of the overall error of the method arising from inaccuracies in pipetting, interference of glutaraldehyde with ethidium bromide (EB) staining and instrumental error. Each adhesion experiment was terminated by staining and post-fixation and it was established that this introduces no change in cell counting, in comparison with the original unfixed cells. Prefixation, however, quenches the EB staining and would interfere with the counting procedure. The overall standard error of the technique was found to be 5%-10%.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗