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Biomedical subjects

J Simmons

Publications and source records attributed to J Simmons.

At least 55 records · Page 3Linked to original sources
PubMed1993

Excessive daytime somnolence in women with abnormal respiratory efforts during sleep.

An abnormal level of respiratory efforts, indicated by significant increase in peak negative esophageal pressure (Pes), can be associated with daytime somnolence in snoring pre-menopausal women. No drop in oxygen saturation (SaO2) or visual evidence of transient electroencephalographic (EEG) arousals can be found at repeat polysomnography. Nasal continuous positive airway pressure (CPAP) titrated on Pes measurements eliminates somnolence.

Adult↗
PubMed1993

Pure red cell aplasia and hepatitis A.

A patient with pure red cell aplasia associated with hepatitis A showed a dramatic and rapid recovery after initiation of oral prednisone therapy. The response to corticosteroid therapy suggests an immune etiology for this life-threatening disorder.

Female↗
PubMed1993

The Occupational Safety and Health Administration's 1990-1991 survey of occupational medical surveillance prevalence and type of current practices.

For all industry divisions, the likelihood that an establishment will have a medical surveillance program increases directly with size of establishment. Among establishments with 1 to 19 employees, only 4% have medical surveillance programs whereas 56% of establishments that employed 250 or more employees had such programs. The most common time to administer medical surveillance is preemployment. The second most common time to conduct medical surveillance is at periodic intervals. The most common component of medical surveillance programs is a general physical examination. This component of medical surveillance is also the most common element of preemployment surveillance, preplacement surveillance, periodic surveillance, preexit examinations, and surveillance for respirator users. Among the group of Phase II establishments, audiometric testing was the most common periodic test identified. Musculoskeletal testing is performed by 45% of firms administering preplacement examinations and by 38% of firms with preemployment examinations. Across all industry divisions, 14% of establishments that have a medical surveillance program also perform biologic monitoring of some employees.

Environmental Monitoring↗
PubMed1993

The purposes of occupational medical surveillance in US industry and related health findings.

The primary purpose for implementing medical surveillance is to protect the general health and fitness of all employees. The next most frequent purpose of medical surveillance programs is to determine whether employees have the physical capability to perform their jobs (ie, surveillance to establish "fitness for duty"). The most commonly reported uses of medical surveillance data for establishments across all industry divisions were to implement or change work practices, to implement or change administrative control programs, to modify training programs, and to change personal protective equipment. Eighteen percent of establishments in all size classes and industries that have medical surveillance programs have identified adverse health effects among employees. The health effects most commonly identified by the medical surveillance programs were repetitive trauma, hearing loss, and skin disorders. Programs designed to detect hearing loss and cumulative trauma disorders, are in fact, finding these adverse effects. Among employees actually receiving periodic medical surveillance tests (6 million), 5% were found to have an abnormal test result.

Humans↗
PubMed1993

Effects of occupational medical surveillance programs as perceived by respondents to the Occupational Safety and Health Administration's 1990-1991 survey.

Among all establishments perceiving a change as a result of their medical surveillance program, 43% of those employing 250 or more employees did so; for the smallest establishments, this figure drops to 7%. The changes most often perceived, regardless of size class of establishment or industry division, were in employee relations, injury rates, and insurance costs. Establishments with the most comprehensive risk reduction strategies were most likely to attribute benefits to their medical surveillance programs. Benefits of medical surveillance perceived by the Phase II respondents include reduced costs, early detection of medical problems, increased productivity, and a reduced injury or illness rate. Most firms have no systematic method or procedures for evaluating the effectiveness of their medical surveillance programs.

Humans↗
PubMed1993

Cardiac failure and benzodiazepines.

Nine patients with stable cardiac failure and mean left ventricular ejection fraction of 30% were investigated. All had previously been prescribed a benzodiazepine hypnotic by their home physicians, but the medication had been discontinued for at least 1 month. Subjects were monitored under three conditions: 1) without any sleeping medication, 2) during nasal CPAP administration and 3) at two points during a month-long administration of the benzodiazepine that had initially been prescribed to them. Overall, the benzodiazepine hypnotic improved the sleep fragmentation noted in these patients by decreasing the arousal index from a mean of 18 +/- 6 per hour at baseline to a mean of 9 +/- 6.5 per hour after one month of benzodiazepine therapy. Total nocturnal sleep time was consequently improved [baseline mean nocturnal total sleep time: 313 +/- 27.3 minutes; benzodiazepine mean nocturnal total sleep time: 350 +/- 17.3 minutes (p < 0.0003)], as was sleep efficiency. However, the benzodiazepine hypnotic had no significant effect on central hypopneas or apneas [baseline mean respiratory disturbance index (RDI): 20.5 +/- 5.85 events/hour; mean RDI after 1 month of drug intake: 21.3 +/- 2.5 events/hour]. Nasal CPAP was also ineffective on the disordered breathing. In this group of subjects, respiration was even significantly worsened with nasal CPAP compared to baseline, as indicated by RDI (p < 0.0001), lowest SaO2 (p < 0.0001) and total nocturnal sleep time (p < 0.0001) measurements.

Benzodiazepines↗
PubMed1992

Electrophysiological effect of the maze procedure on canine sinoatrial node function.

The maze procedure is an operation that has had great initial success in curing atrial fibrillation. This procedure includes several right atrial incisions that may interrupt the integrity of the sinoatrial node or its arterial supply. To assess the effect of the maze procedure on sinus node function (SNF), the following studies were performed: sinus node recovery times (SNRT), corrected SNRT (CSNRT), CSNRT under autonomic blockade maximal heart rate and intrinsic heart rates. Thirty-four dogs underwent a right thoracotomy with cardiopulmonary bypass (CPB). The dogs were divided into three groups. Group 1 (n = 9), the sham group, underwent CPB without any incisions. Group 2 (n = 8) underwent CPB and one of the right atrial incisions. Group 3 (n = 18) underwent CPB and all three of the right atrial incisions. SNF was determined before and after the procedure. Groups 1 and 2 had no significant difference in measured SNF acutely after the procedure. In Group 3 the mean SNRT increased from 552 msec to 1,984 msec (P = 0.005). Sinus node dysfunction was corroborated by all studies. In the chronic studies, a trend toward recovery of SNF was observed. The maze procedure results in significant acute sinus node dysfunction. This dysfunction may resolve spontaneously over the ensuing months. Modifications of the maze procedure that avoid the sinus node or its blood supply area may reduce procedure related sinus node dysfunction.

Animals↗
PubMed1992

From obstructive sleep apnea syndrome to upper airway resistance syndrome: consistency of daytime sleepiness.

Some patients with excessive daytime sleepiness who do not present the features of obstructive sleep apnea syndrome (OSAS) present a sleep fragmentation due to transient alpha EEG arousals lasting between three and 14 seconds. These transient EEG arousals are related to an abnormal amount of breathing effort, indicated by peak inspiratory esophageal pressure (Pes) nadir. In the studied population, these increased efforts were associated with snoring. Usage of nasal CPAP, titrated on Pes nadir values, for several weeks eliminated subjective daytime sleepiness and improved Multiple Sleep Latency Test scores from baseline evaluations. Patients suspected of CNS hypersomnia should be asked about continuous snoring, and their clinical evaluation should include a good review of maxillo-mandibular and upper airway anatomy.

Airway Obstruction↗
PubMed1989

Non-Alzheimer-type pattern of brain cholineacetyltransferase reduction in dominantly inherited olivopontocerebellar atrophy.

We recently reported reduced activity of the cholinergic marker enzyme cholineacetyltransferase (ChAT) in several brain regions of patients with dominantly inherited olivopontocerebellar atrophy (OPCA). To document the regional extent of these changes we performed a comprehensive examination of the behavior of ChAT throughout both cerebral cortical and subcortical brain areas in 5 patients from one large OPCA pedigree. As compared with the controls, mean ChAT activities in OPCA were reduced by 39 to 72% in all (n = 27) cerebral cortical areas examined and in several thalamic subdivisions, caudate head, globus pallidus, red nucleus, and medial olfactory area. In contradistinction to findings in Alzheimer's disease (AD), mean ChAT levels in OPCA amygdala and hippocampal subdivisions were either normal or only mildly reduced. The lack of severe disabling dementia in our OPCA patients compared with AD patients having a similar cortical cholinergic reduction could be explained by an absence of either a marked cholinergic loss in amygdala or hippocampus or significant loss of noncholinergic cerebral cortical and limbic neurons as occurs in AD brain. We suggest that this and other OPCA pedigrees having a cortical cholinergic reduction represent a unique model for the study of behavioral consequences of a more selective cerebral cortical cholinergic lesion rather than a limbic cholinergic lesion.

Adult↗
PubMed1989

Integrating federal health care resources at the local level.

Hospitals throughout the country are increasingly sharing health services, jointly purchasing supplies, and merging. The Veterans Administration (VA)-Department of Defense (DoD) Health Resources Sharing Law of 1982 (PL 97-174) has encouraged much closer relationships between hospitals of these agencies than had existed previously. All VA hospitals within 50 miles of a military treatment facility now have multiservice agreements. Before passage of the law, only a handful of facilities were involved in limited sharing. Closer relationships have led to expanded care for federal beneficiaries at considerable cost savings. In Albuquerque, New Mexico, for example, the VA Medical Center houses the VA and Air Force hospital operations, obviating the need for a separate freestanding hospital. The lack of VA authority to receive reimbursement from the Civilian Health and Medical Program for the Uniformed Services and a lack of a reimbursement incentive for military hospitals to share are identified as factors preventing greater coordination. Even greater local integration of services is likely to occur in the future.

Health Benefit Plans, Employee↗
PubMed1988

Brain tumors in the very young child. Postoperative chemotherapy in combined-modality treatment.

Twelve consecutively diagnosed children with brain tumors, ages 7 to 27 months, were treated by a combined-modality approach featuring aggressive surgical resection followed by chemotherapy and delayed irradiation. Patients received multiple clinical neurologic examinations and psychological evaluations, as well as diagnostic imaging studies, to monitor the efficacy of chemotherapy and toxic effects of therapy. Six of the eight children with residual tumor evident postoperatively on computed tomography scans had objective responses to chemotherapy. The efficacy of chemotherapy was further demonstrated by the lack of disease progression for 7 months or longer in eight children, seven of whom remain free of tumor 19 to 57 months (median, 28 months) from the date of diagnosis. The neurologic status of ten patients improved during treatment. Developmental progress was normal in two, low average in three, and frankly deficient in four of ten children formally evaluated. These results indicate that postoperative chemotherapy, added to a regimen of surgical resection and delayed irradiation, prolong survival with only minimal short term neurotoxicity in the majority of very young children with malignant brain tumors.

Antineoplastic Combined Chemotherapy Protocols↗