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Jackson BS, Chagares R, Nee N, Freeman K. The effects of a therapeutic bed on pressure ulcers: an experimental study. JOURNAL OF ENTEROSTOMAL THERAPY 1988; 15:220-6. [PMID: 3204209 DOI: 10.1097/00152192-198811000-00024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Link RN, Feingold AR, Charap MH, Freeman K, Shelov SP. Concerns of medical and pediatric house officers about acquiring AIDS from their patients. Am J Public Health 1988; 78:455-9. [PMID: 3348474 PMCID: PMC1349375 DOI: 10.2105/ajph.78.4.455] [Citation(s) in RCA: 87] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
To assess the degree of house officers' concerns about acquiring AIDS (acquired immunodeficiency syndrome) from their patients, we surveyed 263 medical and pediatric interns and residents in four housestaff training programs affiliated with seven New York City hospitals with large AIDS patient populations; 258 questionnaires (98 per cent) were returned. Thirty-six per cent of medical and 17 per cent of pediatric house officers reported percutaneous exposures to needles contaminated with blood of AIDS patients. Forty-eight per cent of medical and 30 per cent of pediatric house officers reported a moderate to major concern about acquiring AIDS from their patients. Greater concern about personal risk was noted in those house officers who were earlier in their residency training, who reported having treated a greater number of AIDS patients, and who were in medicine rather than pediatrics programs. Twenty-five per cent of all respondents reported that they would not continue to care for AIDS patients if given a choice. The results demonstrate a substantial degree of concern about acquiring AIDS among house officers caring for AIDS patients and suggest the need for housestaff program administrators for formally address these concerns.
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Klein RS, Phelan JA, Freeman K, Schable C, Friedland GH, Trieger N, Steigbigel NH. Low occupational risk of human immunodeficiency virus infection among dental professionals. N Engl J Med 1988; 318:86-90. [PMID: 3422106 DOI: 10.1056/nejm198801143180205] [Citation(s) in RCA: 161] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
We studied 1309 dental professionals (1132 dentists, 131 hygienists, and 46 assistants) without behavioral risk factors for the acquired immunodeficiency syndrome (AIDS) to determine their occupational risk for infection with human immunodeficiency virus (HIV). Subjects completed questionnaires on behavior; type, duration, and location of their dental practice; infection-control practices; and estimated numbers of potential occupational exposures to HIV. Serum samples were tested for antibodies to HIV and to hepatitis B surface antigen (unvaccinated subjects). Fifty-one percent of the subjects practiced in locations where many cases of AIDS have been reported. Seventy-two percent treated patients who had AIDS or were at increased risk for it. Ninety-four percent reported accidental puncturing of the skin with instruments used in treating patients. Adherence to recommended infection-control practices was infrequent. Twenty-one percent of unvaccinated subjects had antibodies to hepatitis B surface antigen. Only one dentist without a history of behavioral risk factors for AIDS had serum antibodies to HIV. We conclude that despite infrequent compliance with recommended infection-control precautions, frequent occupational exposure to persons at increased risk for HIV infection, and frequent accidental puncturing of the skin with sharp instruments, dental professionals are at low occupational risk for HIV infection.
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Ascer E, White SA, Veith FJ, Morin L, Freeman K, Gupta SK. Outflow resistance measurement during infrainguinal arterial reconstructions: a reliable predictor of limb salvage. Am J Surg 1987; 154:185-8. [PMID: 3631391 DOI: 10.1016/0002-9610(87)90175-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Criteria for abandoning infrainguinal arterial reconstructions in favor of major amputations should include reliable predictors not only of graft patency, but more importantly, of limb salvage. To evaluate the efficacy of intraoperative outflow resistance measurements in predicting limb salvage after infrainguinal bypasses, we have reviewed 134 such operations (64 femoropopliteal and 70 femorodistal bypasses) performed for critical ischemia. Outflow resistance measurements were divided into quartiles for femoropopliteal bypasses (Group A 0.17 mm Hg/ml/min or less, Group B 0.18 to 0.24 mm Hg/ml/min, Group C 0.25 to 0.4 mm Hg/ml/min, and Group D greater than 0.4 mm Hg/ml/min) and femorodistal bypasses (Group A 0.4 mm Hg/ml/min or less, Group B 0.4 to 0.58 mm Hg/ml/min or less, Group C 0.6 to 1 mm Hg/ml/min, and Group D 1 mm Hg/ml/min or greater). One year limb salvage rates for patients who underwent femoropopliteal bypass were 95 percent, 92 percent, 87 percent, and 67 percent from the lowest to the highest quartile (difference not statistically significant), and for those who had femorodistal bypass, they were 51 percent, 75 percent, 48 percent, and 0, respectively (p less than 0.05). Interestingly, 12 month graft patency and limb salvage rates for patients who underwent femorodistal bypass with outflow resistances between 0.59 and 1 mm Hg/ml/min did not correlate well (22 percent and 48 percent, respectively), whereas for those with outflow resistance greater than 1 mm Hg/ml/min, they were 22 percent and 22 percent, respectively. Thus, measurement of intraoperative outflow resistance is a very accurate predictor of limb salvage after infrainguinal bypass operations.
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Kingston TP, Lowe NJ, Whitefield M, Warin AP, Freeman K. Short-contact anthralin therapy for psoriasis using an aqueous cream formulation. Cutis 1987; 39:155-7. [PMID: 3829723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
A pilot study of five patients was conducted using an aqueous anthralin cream (Drithocreme) and demonstrated that between twenty and forty minutes was an effective contact time to produce an improvement in induration of psoriatic plaques. In a further, bilateral controlled study, the anthralin cream was used to treat twenty patients with symmetrical chronic plaque psoriasis. The cream was applied to one side of the body overnight and then to the other side in the morning. Thirty minutes later it was washed off both sides in a bath or shower. The results indicated that both overnight and short-contact treatment were equally effective, and the short-contact treatment reduced staining and irritation.
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Athow-Frost TA, Freeman K, Mann TA, Marks R, Vollum D, Warin AP. Clinical evaluation of fenticonazole cream in cutaneous fungal infections: a comparison with miconazole cream. Curr Med Res Opin 1986; 10:107-16. [PMID: 3709210 DOI: 10.1185/03007998609110427] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
A randomized, double-blind, parallel-group, multi-centre clinical trial was undertaken in 60 patients with dermatophytosis or pityriasis versicolor to compare topical 2% fenticonazole cream with topical 2% miconazole cream. Treatment, by twice-daily application, was for 4 weeks or until earlier complete resolution of disease. Assessment was by laboratory mycological investigation and regular clinical/symptomatic evaluation, both during and for 2 to 6 weeks after therapy. Fifty-three patients satisfactorily completed the trial, 28 of whom received fenticonazole and 25 miconazole. The groups were adequately well-matched. All assessment criteria showed fenticonazole to be at least as efficacious as miconazole, with no statistically significant differences between the two treatments. A number of assessment criteria, however, did show trends in favour of fenticonazole. Fenticonazole resulted in mycological findings becoming negative in 92%, i.e. all but 2 of 25 patients, by the end of treatment and a similar proportion (91%, 21 of 23 patients) remained mycologically negative 2 to 4 weeks after the end of therapy. With miconazole, only 79% (19 of 24 patients) became mycologically negative during treatment and this figure decreased further to 74% (14 of 19 patients) after therapy. Essentially similar results were seen for clinical assessments of erythema, itching and desquamation, these features being significantly and progressively eliminated or improved by both treatments in high proportions of patients during therapy, followed by little tendency to return after the cessation of therapy. Overall clinical assessments demonstrated statistically significant improvement during the second, third and fourth weeks of treatment with both drugs. Only 4 patients (two with each treatment) were reported as showing clinical deterioration at any stage during the trial, in all cases after the end of therapy. There were no reports of local or systemic adverse reactions to either drug, and laboratory screening investigations failed to reveal any signs of toxicity. These results indicate that a 4-week course of twice daily topical 2% fenticonazole cream is extremely well tolerated and is at least as efficacious as an equivalent regimen of 2% miconazole for the treatment of cutaneous dermatophytosis or pityriasis versicolor. Trends in the results suggest that fenticonazole may prove to be more efficacious than miconazole, particularly in relation to elimination of laboratory evidence of persistent fungal infection, which could be reflected in a lower incidence of subsequent relapse of the disease.
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Abstract
The occurrence of Cronkhite Canada syndrome in a 78 year old man is described. The presence of total gastrointestinal mucosal atrophy with nail loss is reported for the first time. It is suggested that the polyps represent residues of aged cells with no absorptive function and that the condition results from the loss of normal proliferative stimuli or acquired resistance to them. The primary biochemical abnormality may be in the affected epithelia but the changes here could alternatively be secondary to failure of synthesis or release of growth factors.
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Freeman K, Warin AP. Acute myelomonocytic leukaemia developing in a patient with psoriasis treated with oral 8-methoxypsoralen and longwave ultraviolet light. Clin Exp Dermatol 1985; 10:144-6. [PMID: 3856495 DOI: 10.1111/j.1365-2230.1985.tb00542.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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161
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Abstract
Two hundred thirty-three British troops were tested before and 2 months after a 6-month period in Belize. No erythematous indurated reactions developed on the initial tests; four subjects developed such reactions on the second test. Three of these subjects had skin ulcers at the time of the second test; the fourth developed an ulcer 2 weeks later. Leishmania braziliensis sp were isolated from all of these ulcers. Two subjects who showed no reaction on either of their tests developed skin ulcers within 1 month of the second test. Leishmania braziliensis sp were isolated from these ulcers. The leishmanin test performed 2 months after return from an endemic area does not provide a satisfactory screening test for leishmaniasis. An indurated reaction correlates well with the presence of disease, but a negative reaction does not exclude this developing later.
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Freeman K, Hewitt M, Warin AP. Two cases of distinctive exudative discoid and lichenoid chronic dermatosis of Sulzberger and Garbe responding to azathioprine. Br J Dermatol 1984; 111:215-20. [PMID: 6466559 DOI: 10.1111/j.1365-2133.1984.tb04046.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
We describe two cases of distinctive exudative and lichenoid chronic dermatosis of Sulzberger and Garbe which showed rapid resolution with azathioprine therapy, having failed to resolve with oral prednisolone.
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Freeman K, Warin AP. Deterioration of liver function during PUVA therapy. PHOTO-DERMATOLOGY 1984; 1:147-8. [PMID: 6527958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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165
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Warin AP, Freeman K, Whitefield M. Staining of the bath by dithranol. West J Med 1984. [DOI: 10.1136/bmj.288.6428.1459-c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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166
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Freeman K, Warin A. Staining of baths by shortcontact dithranol therapy. Br J Dermatol 1984. [DOI: 10.1111/j.1365-2133.1984.tb07476.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Freeman K, Anthony PP, Miller DS, Warin AP. Cronkhite-Canada syndrome. J R Soc Med 1984; 77 Suppl 4:4-5. [PMID: 6512826 PMCID: PMC1439331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
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Abstract
This review outlines the present knowledge of American cutaneous leishmaniasis, a disease which, owing to the increase in international travel, is being seen with increasing frequency in Europe and North America. A knowledge of this disease is of particular importance to the military medical officer as in recent years approximately one-hundred and fifty cases of leishmaniasis have been seen in British troops who have served in Belize. Leishmania braziliensis sp. have been isolated from a number of these cases. Organisms of this complex had not previously been recorded in Belize and the Army Medical Services are therefore in a unique position to study this disease, as well as having a responsibility to ensure its correct management.
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170
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Tatnall F, Freeman K, Graham-Brown R, Monk B, Sarkany I. Darier's disease: a large family tree and two unusual complications. Br J Dermatol 1983. [DOI: 10.1111/j.1365-2133.1983.tb11608.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Eviatar L, Miranda S, Eviatar A, Freeman K, Borkowski M. Development of nystagmus in response to vestibular stimulation in infants. Ann Neurol 1979; 5:508-14. [PMID: 314269 DOI: 10.1002/ana.410050603] [Citation(s) in RCA: 56] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Nystagmus in response to perotatory stimulation by torsion swing or ice-cold caloric (ICC) irrigation of the ear canals was studied in 276 infants from birth to 12 months of age. The percentage of positive responses to perotatory stimulation correlated with gestational age and weight at birth during the first 3 months of life and became comparable among groups by 6 months of age. The quality of perotatory nystagmus did not differ among groups. A direct correlation between the caloric-induced intensity and duration of nystagmus with gestational age and weight at birth was noted during the first 3 months of life. Premature infants showed the weakest responses, and term-delivered, large for gestational age children the strongest responses. ICC-induced nystagmus reached comparable levels for all groups by 6 months except for premature infants, in whom comparable responses were attainedby 9 months of age. Vestibular responses mature over time, with patterns that correlate with gestational age and weight at birth.
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174
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