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Biomedical subjects

H B Simon

Publications and source records attributed to H B Simon.

At least 19 recordsLinked to original sources
PubMed1994

Patient-directed, nonprescription approaches to cardiovascular disease.

The control of coronary artery disease requires both physician-directed interventions and patient-directed lifestyle changes that may include nonprescription supplements. All patients should be encouraged to exercise regularly. They should be advised to avoid exposure to tobacco smoke and to strive to attain ideal body weight. Patients should also be encouraged to establish diets that are low in cholesterol and fat and high in dietary fiber. Supplements of water-soluble fiber may be useful for selected patients. Diets rich in antioxidant vitamins should also be stressed. Antioxidant supplements may be warranted in individuals with coronary artery disease or risk factors. Pending further study, patients should be encouraged to consume more fish but not fish oil supplements. Therapeutic doses of niacin should not be used without medical supervision. Chromium and other nutritional supplements, however, may merit consideration in selected cases. Physicians should stress the use of nonpharmacologic means to reduce blood pressure and discuss interventions that could reduce excessive stress. With appropriate screening and precautions, selected individuals should benefit from low-dose aspirin prophylaxis and possibly from low-dose alcohol consumption. Because these patient-directed interventions receive less attention in the scientific literature, they were selected for review herein.

Antioxidants↗
PubMed1994

Hyperthermia and heatstroke.

Occurring chiefly in epidemics during hot, humid summer weather, heatstroke dramatically demonstrates the consequences of uncontrolled body temperature elevation. It also illuminates the mechanism and management of unusual hyperthermic disorders associated, for example, with neuroleptic and anesthetic drugs.

Adult↗
PubMed1993

Hyperthermia.

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Body Temperature Regulation↗
PubMed1993

Computed tomography and histologic results in the early stages of endotoxin-injured pig lungs as a model for adult respiratory distress syndrome.

RATIONALE AND OBJECTIVES: To determine early radiographic changes in diffuse alveolar injury, the authors correlated computed tomography (CT) and histopathology in pigs with recurrent endotoxinemia. METHODS: Five pigs received recurrent endotoxin over a 17-hour period. Three pigs received physiologic saline and served as controls. Hemodynamic and blood-gas data were analyzed. CT was performed immediately before killing the animals. The lungs were cut into 5-mm-thick slices in the same axis as the CT scans and were investigated by light and electron microscopy. RESULTS: Hemodynamic data, blood-gas analysis, and morphologic changes closely simulated the clinical situation of septic shock in the five pigs that had received endotoxin. Results of histologic examination depicted changes similar to those associated with adult respiratory distress syndrome (ARDS). CT clearly demonstrated both interstitial, and to a minor degree, intra-alveolar lesions in the endotoxin-injected group, which correlated well with dilated lymph vessels, thickened interstitium, and areas of dystelectasis on histologic examination. Although there was a rather uniform clinical picture, CT and histologic findings showed different degrees of involvement. CONCLUSIONS: CT clearly depicts changes in endotoxin-injured pig lungs in an early clinical state, which are similar to changes associated with ARDS on histologic examination.

Animals↗
PubMed1992

[The effects of the carbon dioxide pneumoperitoneum in laparoscopic cholecystectomy on postoperative spontaneous respiration].

Laparoscopic cholecystectomy (LSC) is being performed increasingly often. The carbon dioxide cavity increases end-expiratory carbon dioxide (exCO2), which can be regulated by mechanical ventilation. Because about 20-40% carbon dioxide remains in the patient at the end of surgery, we were interested in its influence on spontaneous respiration. PATIENTS AND METHODS. Fifteen patients classed as ASA 1-2 and undergoing LSC were compared with 15 patients (also ASA 1-2) undergoing laparotomy for cholecystectomy (LAP). All patients had balanced anaesthesia with fentanyl, enflurane, nitrous oxide and vecuronium. After surgery they were extubated when spontaneous respiration and vigilance were adequate. In the next 3 h we continuously determined exCO2 in the expired air through an intranasal catheter, and oxygen saturation (SAT), respiratory rate (RR) and heart rate (HR) using Oscar (Datex) and Ohmeda (Braun) apparatus while the patients were breathing room air. The blood pressure (BP) was determined intermittently. Postoperative pain treatment was standardized. RESULTS. The groups were reduced comparable with respect of the anthropometric data, because the weight was significantly higher in the LAP group. Fentanyl consumption was also significantly higher in the LAP group, reflecting the more pronounced trauma than with LSC. Mean exCO2 was 46 mmHg after LSC and 36 mmHg after LAP (P less than or equal to 0.05), continuously decreasing in the LSC group and increasing in the LAP group to 40 mmHg after 3 h. Mean RR was 18-20.min-1 after LSC and 12-15.min-1 after LAP during this period (P less than or equal to 0.05). There were no differences in SAT (94-96%), HR (75.min-1) and BP (130/80 mmHg). DISCUSSION AND CONCLUSIONS. The remaining carbon dioxide after LSC has important implications for postoperative spontaneous respiration. Probably due to an activation of carbon dioxide receptors, RR is increased to eliminate residual carbon dioxide. This is confirmed by a significantly increased exCO2 compared with that in the LAP group. This effect lasts at least 3 h, exCO2 being comparable in both groups, but RR is still increased after LSC. This different respiratory pattern does not affect SAT, being normal without hypoxic episodes. Cardiovascular parameters were also normal without group differences. We conclude that the carbon dioxide peritoneal cavity has important consequences for postoperative ventilation. Using our anaesthetic technique and postoperative treatment exCO2 reaches normal values after about 3 h due to an increased RR. If other methods, e.g., stronger opioids, which decrease carbon dioxide response are used, this effect may even be prolonged and more pronounced. We are now performing an investigation to evaluate this effect.

Adult↗
PubMed1991

[Effects of a defined infusion of 10% HAES 200/0.5 in the early phase of a septic syndrome on hemodynamic parameters].

In an animal model the hemodynamic effects of three infusions of HES during the early stage of a septic syndrome were examined. In nine pigs with a body weight between 29 and 36 kg a septic syndrome was produced by infusion of E. coli endotoxin. 1, 4 and 7 hours after beginning of the endotoxin infusion 250 ml HES 200/0.5 were infused. After the 1st and 3rd infusion an increase of the cardiac output resulted, which was previously lowered, without changes of the CVP. During normal CO the 2nd infusion shows an increase of CVP and MAP. PWP did not change. The reactions of the hemodynamic parameters can be well explained physiologically. A volume supply at a reduced CO increases the latter without influence of the CVP. Normalized CO before the infusion resulted in a CVP-increase. The PWP is not evaluable under the conditions of an elevated pulmonary resistance, as it exists at the septic syndrome.

Animals↗
PubMed1991

[The effect of fentanyl on spontaneous respiration].

UNLABELLED: AIM OF THE INVESTIGATION: The effects of fentanyl on spontaneous respiration have been investigated in both animals and humans. The investigations in humans have been performed under circumstances and using methods that do not relate the results to clinical practice, e.g., predicting the effects of opioids used for postoperative pain relief on the ward. We investigated the effects of fentanyl on mechanical parameters, oxygen saturation (SAT), and end-expiratory CO2 (exCO2) in humans. METHODS: Fifteen male volunteers took part in this study, which was approved by the local ethics committee. Each received 3 micrograms/kg fentanyl intravenously after 5 min measurement of base-line values and were observed for 30 min. We continuously registered thoracic (A1) and abdominal (A2) extension and respiratory rate (RR) using piezoceramic elements. SAT, heart rate (HR), and exCO2 were measured with a pulse oximeter and infrared absorption (OSCAR, Datex). All data were transferred to a high-performance microcomputer (Multitalent, ZAK). The statistical analysis included descriptive and correlation statistics. RESULTS: After the injection of fentanyl A1, A2, RR, HR, and SAT were reduced; exCO2 increased. After a few minutes A1 increased, occasionally exceeding the base-line value. A2, RR, HR, and SAT increased without reaching base-line values. ExCO2 remained increased. The best overall correlation was found between A2 and SAT (r = 0.87). DISCUSSION: As far as comparable, our results are in accordance with those of the majority of other investigators. The difference between thoracic and abdominal extension, the latter being closely correlated with tidal volume, has not previously been described quantitatively. We attribute this result to the different innervation of the phrenic and intercostal nerves. Whereas the influence of fentanyl on SAT and exCO2 during the first 8 min can easily be explained, the varying behavior in the following minutes has not previously been described and may be due to the different binding characteristics of O2 and CO2. Alteration of the CNS setting for pCO2 may also contribute to this result. The time course of the measured parameters seems to be of clinical importance for the detection of respiratory problems in spontaneously breathing patients.

Adult↗
PubMed1990

[Effects of various alfentanil doses on blood pressure, heart rate and plasma catecholamine level in endotracheal intubation].

METHOD: In 56 patients undergoing arthroscopy of the knee blood pressure (BP), heart rate (HR) and plasma catecholamines were measured during induction of anaesthesia. To a standard treatment including etomidate (K), either 1 (A1), 2 (A2) or 3 (A3) mg alfentanil were added. The control-group included 8 patients, the other groups consisted of 16 patients. Blood pressure and heart rate were measured the day before anaesthesia (T1), at the arrival in the operation theatre (T2), 1 minute after the induction (T3) and 1 minute after intubation (T4). Catecholamines were analysed at T2 and T4. - RESULTS: At T1 and T2 no significant differences were measured. The control-group had a significant rise of BP, HR and adrenalin at T4. In group A1 (1 mg alfentanil) BP and catocholamines remained at the same levels, HR rose significantly. In group A2 all parameters did not change. The group A3, BP dropped significantly, whereas the other parameters remained stable.- DISCUSSION: 2 mg Alfentanil given 1 minute before endotracheal intubation depress the sympathoadrenergic reactions but do not impair the circulation.

Adolescent↗
PubMed1988

[Methohexital/alfentanil-thiopental/alfentanil for total intravenous anesthesia for direct laryngoscopy with 100% O2 jet ventilation].

For the direct laryngoscopy and microscopic examination of the larynx with exploratory excision and pulpectomy using low frequency jet-ventilation with 100% oxygen we used total intravenous anaesthesia with a strong acting opioid and a barbiturate. Because the achievement of sufficient reflexes and a high degree of vigilance postoperatively are to be aimed, Methohexitone (M) and Thiopentone (T) were investigated in the regard of the suppression of vigilance in the postoperative period. 40 patients were randomly assigned to the group M (n = 20) or T (n = 20). The evening before operation, an intelligence test and a syndrome-short-test (SST) were performed for the measurement of attention and memory (functional psychosis). The patients received 2 mg Flunitrazepam orally and transdermal Scopolamine. On the day of operation the patients received 1 mg Lormetazepam orally for premedication. Anaesthesia was induced with 2 mg Alcuronium, 1 mg Alfentanil, 1.4 mg/kg bodyweight M respectively 5 mg/kg bodyweight T and 1.4 mg/kg bodyweight Succinylcholine. Immediately before laryngoscopy the patients received 2-4 mg Alfentanil. Muscle relaxation was achieved by an infusion with Succinylcholine using relaxometry. Methohexitone respectively Thiopentone were administered by infusion depending on clinical signs indicating insufficient anaesthesia. The following parameters were measured: Blood pressure, heart rate, duration of operation and anaesthesia, parameters of vigilance 30, 60 and 120 minutes after operation (SST) and the ability of performance. The groups were comparable with respect to all data except the parameters of vigilance. The patients receiving M were significantly more vigilant 30 min., 60 min. (SST) and 120 min (SST) after the end of anaesthesia than patients receiving T (p = 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1986

Extreme pyrexia.

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Body Temperature Regulation↗
PubMed1984

The immunology of exercise. A brief review.

Many athletes believe that habitual exercise protects them against infection. This article reviews ten studies of the effects of exercise on various host-defense factors. Exercise produced a transient granulocytosis and lymphocytosis, and in some studies, lymphocyte function was reported to have been enhanced. Serum immunoglobulin and complement levels were not significantly altered in the small number of subjects studied. Two recent studies showed that exercise produced an increase in circulating endogenous pyrogen in man. Since it now appears that endogenous pyrogen is identical to interleukin-1, a product of mononuclear cells that enhances lymphocyte function, it may play a role in host defense. Further studies will be needed before it can be concluded that exercise effects the host response to infection in any clinically meaningful way.

Adult↗
PubMed1984

Creatine kinase levels after jogging in patients with cardiac disease.

Acute muscle injury is a well-documented complication of strenuous exercise, but milder forms of exertion have not been studied in detail. This report describes a patient undergoing cardiac rehabilitation in whom atypical chest pain developed and who was treated for a myocardial infarction only because of an elevated creatine kinase level. Serum creatine kinase levels were determined before and after exercise in 27 patients undergoing cardiac rehabilitation. In 21 patients who jogged less than three miles, creatine kinase levels were not appreciably changed. In six patients who jogged more than three miles, the mean creatine kinase level rose from 41 to 54 mU/ml, an increase of 31 percent. In four of these six patients, creatine kinase levels rose to abnormal levels, but MB creatine kinase levels remained normal, with no clinical evidence of myocardial ischemia. Serum creatine kinase levels should be interpreted with caution in the setting of even modest exercise.

Adult↗
PubMed1984

Indolent meningococcal meningitis: a cautionary tale.

Bacterial meningitis is a medical emergency that is ordinarily rapidly progressive. We present three patients who had meningococcal meningitis with an indolent course. Symptoms were present from two days to four weeks before hospitalization. Cerebrospinal fluid cultures grew Neisseria meningitidis one to eight days before antibiotic therapy, yet all patients remained fully alert and clinically stable during this interval. All recovered after penicillin therapy. In the future earlier diagnosis should be facilitated by an awareness of differing manifestations of meningococcal meningitis, including benign CSF findings, intact sensorium, and an indolent progression. Immunologic studies will be required to clarify the pathogenesis of this syndrome.

Adult↗
PubMed1980

Hemophilus influenzae in hospitalized adults: current perspectives.

In an eight year period 16 cases of serious extrapulmonary Hemophilus influenzae infection in adults were identified, including cases of meningitis, pericarditis, epiglottitis, empyema, cellulitis, osteomyelitis, endometritis, urinary tract infection, orbital cellulitis, primary peritonitis, mesenteric lymphadenitis and aortic graft infection. An 18 month prospective study of H. influenzae infection in hospitalized adults identified 10 cases of bronchitis, 25 of pneumonia and 65 of respiratory tract colonization, but there were no extrapulmonary infections. In 29 percent of the respiratory tract infections, H. influenzae appeared to be a nosocomial pathogen; in 71 percent, the infection was mixed. Finally, 110 clinical isolates of H. influenzae were studied for antimicrobial susceptibility. Eight percent were ampicillin resistant, two strains were resistant to tetracycline and one to chloramphenicol, but all were susceptible to trimethoprim-sulfamethoxazole and cefamandole.

Adolescent↗
PubMed1979

Hormonal hyperthermia: endocrinologic causes of fever.

Although hyperthermia is a component of many endocrine diseases, it is uncommon for fever to be the presenting manifestation of hormonal disorders. During a four year period we encountered six patients, hospitalized principally because of fever, who were found to have endocrine causes for the fever. In all, the admitting diagnosis was infection; three were suspected of having tuberculosis, two of gram-negative bacteremia and one of endocarditis. Except for asymptomatic bacteriuria in one patient (who remained febrile despite appropriate antibiotic therapy) infection was ruled out in all cases, and fever was attributed to "masked" thyrotoxicosis, triiodothyronine (T3) toxicosis, subacute thyroiditis, primary adrenal insufficiency, secondary adrenal insufficiency and pheochromocytoma. In a seventh patient, extreme pyrexia developed in the setting of the thyroid storm. The importance of hormonal mechanisms in thermoregulation is discussed.

Addison Disease↗