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Biomedical subjects

R Freeman

Publications and source records attributed to R Freeman.

At least 271 records · Page 15Linked to original sources
PubMed1990

Management of cytomegalovirus antibody negative patients undergoing heart transplantation.

In a series of 61 consecutive patients undergoing heart, heart and lung, and lung transplantation, 24 patients were known to be cytomegalovirus (CMV) antibody negative on the day of transplantation. Enzyme linked immunosorbent assays (ELISA) for CMV IgG were performed on donor samples on the day of operation. In 16 of the 24 susceptible patients the test was negative and the only preventive measure taken was the use of blood and blood products from CMV-antibody negative blood donors. None of these patients acquired primary infection with CMV. In another six patients the donor serum was found to contain CMV specific IgG, and in these patients, including one heart and lung transplant recipient, prophylaxis with CMV specific hyperimmune globulin was given. All six patients developed CMV IgM antibodies and in five there was an associated but clinically mild illness. None of these patients required treatment. In the remaining two patients ELISA tests on the donor sera gave equivocal results and hyperimmune globulin was withheld. Both patients developed primary CMV infection of greater severity than those given hyperimmune globulin and one required treatment. Reference tests confirmed that the donor sera contained CMV antibodies. Primary CMV infection in susceptible patients after heart transplantation can be avoided by the use of screened blood and blood products where the organ donor is seronegative to CMV and it can be improved by the use of prophylactic hyperimmune globulin where the donor is CMV antibody positive.

Antibodies, Viral↗
PubMed1990

Autonomic function and human immunodeficiency virus infection.

We compared autonomic function in 26 patients infected by the human immunodeficiency virus (HIV) (18 AIDS and 8 ARC) to 22 controls. A significant decline in autonomic function was present across groups. Autonomic dysfunction correlated strongly with signs of HIV-associated nervous system disease. We observed significant differences across groups in tests of heart rate variation (expiratory-inspiratory ratio, maximum minus minimum heart rate difference, and mean square successive difference), the mean arterial blood pressure fall to tilting, and the blood pressure response to isometric exercise. A trend of declining autonomic function from controls to AIDS was present in the 30:15 ratio, the Valsalva ration, the systolic blood pressure fall to standing and tilt, and the cold pressor test. We did not observe any correlation between autonomic dysfunction and individual neurologic signs, prior therapeutic agents, and concurrent HIV-associated inflammatory or neoplastic processes. This study provides support for the presence of autonomic dysfunction in association with HIV infection. Autonomic dysfunction occurs more frequently and with greater severity in patients with AIDS; however, it may be present in the early stages of HIV infection and appears to progress during the illness.

AIDS-Related Complex↗
PubMed1990

The pharmacotherapy of depressive illness in adolescence: I. An open label trial of imipramine.

The efficacy of imipramine hydrochloride (IMI) for adolescents with major depressive illness meeting Research Diagnostic Criteria (RDC) and DSM-III criteria was assessed in an open-label trial of 35 inpatients. Patients were treated for 6 weeks up to a target dosage of 5 mg/kg/day and assessed weekly by the Hamilton Rating Scale for Depression (HAM-D) and Clinical Global Impressions Improvement scale (CGI). A total of 34 patients in the sample completed the trial, 28 achieving the full target dosage (mean = 222 mg; mean IMI plus desmethylimipramine (DMI) plasma level = 237 ng/ml). Among 24 nondelusional patients, only one third were considered responders based on pattern analysis of the time of onset and persistence of symptom reduction. Among 10 delusional patients, the response rate was 10 percent. Although total IMI plus DMI plasma level did not differ between responders and nonresponders, no responder had a level below 180 ng/ml. In univariate linear regression analysis, no single variable was predictive of response status at 6 weeks. These findings underscore the importance of a comprehensive study of the potency of antidepressant compounds in adolescents and the need for further investigation of psychobiological process mediating drug effects.

Adolescent↗
PubMed1990

Antimicrobial prophylaxis in cardiovascular surgery.

Antimicrobial prophylaxis for cardiovascular surgery has a long history despite there being surprisingly little formal proof of the need for it. The stated aims of chemoprophylaxis are prevention of early prosthetic valve endocarditis (EPVE) and sternotomy infections after coronary artery bypass graft (CABG) surgery. Comparisons of narrow spectrum prophylaxis (flucloxacillin) and broad spectrum prophylaxis (cephradine) within a unit dedicated to open-heart surgery over a prolonged period suggest that narrow spectrum prophylaxis offers acceptably low levels of both infective complications whilst minimising colonisation of the patients with Gram-negative bacilli and yeasts. Some of the infective complications of open-heart surgery (intravascular catheter infections and urinary tract infections) are amenable to prevention by non-antibiotic means.

Anti-Infective Agents↗
PubMed1990

Why inner city mothers take their children for routine medical and dental examinations.

The preventive behaviour relating to visits for dental and medical examination of 100 mothers of pre-school children was investigated. The theory of reasoned action of Fishbein and Ajzen was used to predict the intention of 100 mothers to visit doctors and dentists. The study was conducted in one of the most socially deprived wards of the London Borough of Bloomsbury. The relationship between beliefs and attitudes held by mothers on preventive dental and repeated medical visits was investigated. In younger mothers aged 16-24 years, individual attitudes and subjective norms were better predictors of intention to visit the dentist every 6 months than were the total attitude and total subjective norm scores. The prediction of intention to visit the doctor and the dentist showed a similar pattern, but the variance accounted for by intention to visit the doctor was lower. Younger mothers showed stronger attitudes associated with dental treatment outcome, whereas older mothers showed a more positive preventive dental orientation. This finding is supported by principal components analysis of both the medical and dental data. The theory of reasoned action was successfully applied, but the external variable age was a very important prediction factor. This modifying factor, in relation to Ajzen and Fishbein's theory, gives a better insight into preventive dental and medical health behaviours.

Adolescent↗
PubMed1989

No specific association between primary biliary cirrhosis and bacteriuria?

160 consecutive patients with primary biliary cirrhosis (PBC) (M:F, 13:147; total samples 286), 140 patients with other chronic liver disease (CLD) (M:F, 75:65; total samples 200), and 28 patients with primary Sjögren's syndrome (all F; total samples 37), were examined for bacteriuria over 6 months by midstream urine (MSU) examination. The overall prevalence of bacteriuria in PBC was 11.2% (7.5% on first MSU), in CLD 12.1% (10.7% on first MSU), 18.4% in the 65 female CLD patients, 10.7% in Sjögren's syndrome patients (3.5% on first MSU). The prevalence of bacteriuria was related to the age of the patient (P less than 0.02) in PBC and to the presence or absence of cirrhosis in both PBC and CLD (P less than 0.02). There was no difference in the prevalence of bacteriuria between PBC and CLD patients taken as a whole or among females alone, cirrhotic or non-cirrhotic groups. In a second prospective study of the cumulative incidence of bacteriuria in PBC versus CLD and Sjögren's no significant differences between groups was observed but among 29 PBC patients the cumulative proportion of positive tests for bacteriuria after 5 months (monthly testing) was 34%. We conclude that there is no specific association between PBC and bacteriuria compared with the prevalence of bacteriuria in other CLD.

Adult↗
PubMed1989

Opportunist pulmonary infection with Legionella bozemanii.

Three cases of pulmonary Legionella bozemanii infection in immunocompromised patients are described. The diagnosis was made by culture in each case and would not otherwise have been made, and it is recommended that a culture specific for Legionella species should be included in the investigation of patients with suspected opportunist pulmonary infections.

Adult↗
PubMed1989

Anti-sympathetic nervous system autoantibodies. Diminished catecholamines with orthostasis.

The etiology of autonomic neuropathy in insulin-dependent diabetes mellitus (IDDM) is unknown. Previous studies have noted the presence of anti-adrenal medullary antibodies in IDDM. Recently, we have also demonstrated the presence of anti-sympathetic ganglia antibodies in IDDM. We initiated a study to evaluate whether subjects with complement-fixing anti-adrenal medullary (CF-ADM) and anti-sympathetic ganglia (CF-SG) antibodies have a decreased catecholamine response to change in posture. Seven IDDM subjects aged 19-41 yr with duration of disease 5-21 yr at the time of the posture study were evaluated. Serums collected longitudinally were evaluated for the presence of CF-ADM and CF-SG antibodies. Three IDDM subjects were CF-ADM- and CF-SG- at all testing intervals (Ab- group). Four IDDM subjects were CF-ADM+ and/or CF-SG+ on at least one testing date (Ab+ group). Baseline mean norepinephrine and epinephrine levels were not significantly different in Ab+ and Ab- subjects. Norepinephrine levels 5 min after standing were mean +/- SD 227 +/- 16 and 419 +/- 48 pg/ml for Ab+ and Ab- subjects, respectively (P less than .03). The means of the 5-min minus basal norepinephrine levels were 88 +/- 42 (Ab+) and 207 +/- 26 (Ab-) pg/ml (P less than .03). Mean epinephrine levels after 5 min of standing were 35 +/- 16 (Ab+) and 101 +/- 44 (Ab-) pg/ml (P less than .03). The means of the 5-min minus basal epinephrine levels were 1 +/- 5 (Ab+) and 43 +/- 38 (Ab-) pg/ml (P less than .03).(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenal Medulla↗
PubMed1989

Early results of single lung transplantation in patients with end-stage pulmonary fibrosis.

Three patients underwent single left lung transplantation for end-stage pulmonary fibrosis between June and November 1987. Preoperatively all were housebound, receiving continuous, supplemental oxygen, and their pulmonary function had deteriorated despite corticosteroid and cyclophosphamide therapy. Pulmonary preservation was by means of pulmonary arterial perfusion with modified Euro-Collins solution, 60 ml/kg, at 4 degrees C with adjunctive iloprost (synthetic prostacyclin) infusion. The heart from each donor was used successfully for transplantation. Good early graft function enabled extubation 11, 46, and 96 hours after transplantation. An omental wrap was used around the bronchial anastomosis, and bronchial healing was satisfactory in all. All patients had episodes of pulmonary rejection diagnosed by a combination of symptoms, chest x-ray infiltrates, the exclusion of pneumonitis by bronchoalveolar lavage, and prompt response to "pulse" steroid therapy. Two of the three patients had three episodes of opportunistic pulmonary infections: Herpes simplex pneumonitis, Pneumocystis carinii infection, and Aspergillus pneumonitis. The three patients were discharged from the hospital after 5, 6, and 7 1/2 weeks, respectively. The first and third patients remain alive and well, living essentially normal lives 24 and 19 months after transplantation with no evidence of arterial desaturation on exercise testing while breathing room air. The second patient had symptoms of deteriorating lung function with a progressive decline in forced expiratory volume in 1 second, vital capacity, and diffusion capacity despite repeated "pulse" therapy with combinations of methylprednisolone, antithymocyte globulin, and OKT3 (Ortho Diagnostic Systems Inc., Raritan, N.J.). An open lung biopsy specimen showed obliterative bronchiolitis, and this patient underwent orthotopic lung retransplantation, on the right side. Despite excellent early graft function and early extubation, he died of uncontrolled rejection and general debility after 3 weeks. This early experience in our center with two of three patients surviving 19 to 24 months, respectively, confirms the restoration of good pulmonary function and near normal life-style in patients with end-stage pulmonary fibrosis after single lung transplantation, as first reported by the Toronto Lung Transplant Group. We have used an alternative method of lung preservation (cold crystalloid pulmonary perfusion as opposed to topical cooling, used by the Toronto group), which provided excellent pulmonary preservation up to and beyond 4 hours' storage.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1988

Reduction of post-operative swelling by a placebo effect.

A placebo effect on post-operative swelling was investigated as a possible model for studying psychological influences on recovery from surgery. 79 patients undergoing removal of impacted third-molars received one of five different procedures shortly after emerging from general anaesthetic. These included dentist-administered or placebo ultrasound (the latter given in two different ways to control for massage effects), untreated controls and a group instructed to apply facial massage to themselves. Pre- and post-operative measurements included trait and state-anxiety, coping style, emotional state, pain, plasma cortisol and facial swelling. Cortisol levels correlated with anxiety and avoidant coping. Post-operative anxiety was negatively correlated with pre-operative arousal. Neither coping nor emotional state was affected by the treatments, but swelling was reduced by a placebo effect of ultrasound. Cortisol levels also responded, apparently to an effect of massage. The coping and emotional factors which we measured here cannot, therefore, explain the effects of this psychological procedure on post-operative recovery.

Adaptation, Psychological↗
PubMed1988

Oral hygiene behavior and periodontal status in European adolescents: an overview.

The object of this review is to examine toothbrushing as a health behavior in European adolescents. The aims are to investigate the role of environmental and social factors on toothbrushing as a health behavior, to illustrate the importance of such factors in the prevention of periodontal diseases and to demonstrate how a knowledge of these factors can aid the development of specific health education programs. In order to do this the results of many studies concerned with oral hygiene behavior from different European countries have been examined. It is from the detailed study of these various European investigations that the results section is composed. The findings from this review demonstrate that toothbrushing as a health behavior is influenced by both environmental and social factors, that both of these factors affect the incidence of gingivitis and periodontal disease in the countries examined, and that when they are incorporated into health education programs based on the community development approach they can aid behavior change.

Adolescent↗