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Biomedical subjects

R Simmons

Publications and source records attributed to R Simmons.

At least 55 records · Page 3Linked to original sources
PubMed1990

Effective therapy of glucocorticoid-induced osteoporosis with medroxyprogesterone acetate.

The effect of long-acting medroxyprogesterone acetate (MPA) on the trabecular bone density in patients with glucocorticoid-induced osteoporosis (GCO) was evaluated. Thirteen steroid-dependent asthmatic male patients with GCO were administered 200 mg MPA intramuscularly at 6-week intervals and 1 g of elemental calcium daily for a period of 1 year. Ten additional matched steroid-dependent asthmatic male patients received 1 g of elemental calcium daily (controls). All 23 patients involved in the study had vertebral trabecular bone densitometry (TBD) by quantitative computed tomography (QCT) at baseline and at 6 and 12 months into the study. A 17% increase in TBD was found in the MPA-treated patients at 1 year (from 68.5 +/- 5 to 80.2 +/- 4 mg K2HPO4/cc) in contrast to the control group who experienced a 21% decrease in TBD during the same period of time (from 80.5 +/- 7 to 63.7 +/- 8 mg K2HPO4/cc) (T = 6.90, P = 0.0001 df = 21). There were no significant changes in other parameters followed during the study in the MPA-treated group (serum calcium, phosphorus, magnesium, PTH, alkaline phosphatase, triglycerides, total and HDL cholesterol, urinary excretion of calcium, phosphate, creatinine) except for a decrease in the serum luteinizing hormone (LH) and testosterone (P less than 0.01) as well as of the hydroxyproline-creatinine ratio (P less than 0.01). The results lend support to the hypothesis of a progesterone-glucocorticoid competitive antagonism at the bone level, though other possibilities can be entertained, and suggest MPA as an effective therapy for glucocorticoid-induced osteoporosis in men.

Aged↗
PubMed1990

Early tissue response to transscleral neodymium: YAG cyclophotocoagulation.

Transscleral cyclophotocoagulation was performed with a neodymium: YAG laser on five patients 24-72 hr before enucleation for a blind, painful eye. The thermal mode at 20 ms and a maximum offset between aiming and therapeutic beams were kept constant. Variable parameters evaluated were energy levels between 2 and 8 J and distance from the limbus of 0.5-3.0 mm. Because of the underlying distortion in three of the eyes, meaningful interpretation by light microscopic evaluation was possible only in the other two. This suggested that the early histologic hallmark of the procedure is similar to that previously observed in human autopsy eyes with ciliary epithelial damage and elevation from underlying tissue. In addition, fibrin and scant inflammatory cells were seen in the space between ciliary epithelium and stroma. Minimal damage was observed in the ciliary muscle. These findings suggest that direct damage to the ciliary epithelium is the most likely mechanism of reduced aqueous production by this cyclodestructive procedure. The findings also support the concept that an anterior placement of approximately 1.0-1.5 mm posterior to the limbus is most likely to damage the ciliary epithelium of the pars plicata.

Ciliary Body↗
PubMed1989

Hepatic dysfunction in multiple systems organ failure as a manifestation of altered cell-cell interaction.

Multiple organ failure continues to be the primary cause of death after trauma and sepsis. This clinical syndrome follows shock and resusitation and the transition from a hypermetabolic response to a syndrome of progressive organ failures and death. Risk factors include: perfusion deficits, persistent foci of dead or injured tissue, an uncontrolled focus of infection, the presence of the respiratory distress syndrome, and preexisting fibrotic liver disease. The imitation of the syndrome represents the clinical manifestation of hepatic failure. It is hypothesized that this hepatic failure results from paracrine amplification with Kupffer cell induced hepatocyte cytotoxicity. The best treatment remains prevention and rapid control of risk factors including restoration of oxygen transport and aggressive nutrition support. There seems to be no treatment "magic bullet" either experimentally or clinically once the syndrome has occurred.

Animals↗
PubMed1989

Collaboration in action.

A neighborhood health center and a school of nursing in the southwest collaborated in a pilot project to offer two workshops for low-income, Hispanic diabetics. The collaboration process used participatory management and change theories, accepted and incorporated features of Hispanic culture, and fostered interpersonal relationships. The project enabled the center to augment its client education services while providing a teaching experience for nursing students. Through the workshops, clients gained knowledge and skills that enabled them to institute life-style changes in meal planning, medication management, exercise routines, and community involvement.

Community Health Centers↗
PubMed1988

Nonpalpable breast lesions at biopsy. A detailed analysis of radiographic features.

Several studies have demonstrated that mammographic screening of asymptomatic women results in a lower mortality rate where breast cancer is concerned. Often, screening mammograms reveal a nonpalpable radiographic abnormality and the diagnosis must be determined by an excisional biopsy after radiographic needle localization. The mammographic features associated with 179 nonpalpable breast abnormalities biopsied after radiographic needle localization were carefully characterized. There were 41 carcinomas (23%) in the series. The aim of this study was to determine which radiographic findings, if any, strongly portend the presence of either a malignant or benign lesion. Mammographic features that were commonly associated with malignancy include a change from a previous mammogram, a distortion of the surrounding architecture, the association of a soft tissue density and calcifications, and the presence of more than ten calcifications in the lesion. The radiographic abnormalities which were more commonly associated with benign disease include well-defined densities without calcifications, asymmetric densities without calcifications, and abnormalities consisting solely of a focus of mammographic calcifications that have fewer than ten concretions. The incidence of malignancy in lesions having these mammographic characteristics was only 5.5%. On the basis of these results alone, no firm threshold for biopsy can be recommended. The risks of deferring biopsy until there is worsening of the mammographic image remains to be determined.

Biopsy, Needle↗
PubMed1988

Pathologic considerations in the high-risk breast patient.

An understanding of the spectrum of benign breast changes is necessary to optimize diagnosis and treatment. To evaluate the relative risk for developing cancer with benign breast lesions, each of the entities included in the category of benign breast conditions is discussed individually.

Adenofibroma↗
PubMed1988

Chronic illness and infant-mother attachment: cystic fibrosis.

In order to evaluate the effects of a chronic potentially lethal illness on infant-mother relationships, we assessed 23 infants diagnosed with cystic fibrosis (CF) in the first year of life and 23 healthy controls in Ainsworth's "strange situation" paradigm for attachment at 12-18 months of age. There were no differences in distribution of attachment patterns between the CF infants and the controls, or between either group and published norms. Comparisons between securely and insecurely attached infants in the CF group indicated that, although they did not differ in measures of initial severity of illness, the insecure group was diagnosed significantly earlier and had significantly lower weight and weight for height at 12-18 months. Although the sample is small, these findings point to the possible psychosocial impact of illness and the role that psychosocial factors can play in the health and growth of infants.

Child Development↗
PubMed1986

Psychologic adjustment of the family with a member who has cystic fibrosis.

Seventy-eight percent of the 384 patients 2 years of age and older who were enrolled in the Cystic Fibrosis Clinic at the Hospital for Sick Children participated in this study of family adjustment to cystic fibrosis. Residence with at least one parent at the time of the survey was a condition for inclusion in the study. The effect of the disease on the family was assessed using three questionnaires: an inventory of family problems as perceived by the parents and two standardized measures of family interaction. Measures of behavior and self-concept in each patient and sibling, physical disease parameters for each patient, and demographic characteristics of the families were examined and analyzed in relation to the responses to the questionnaires on family interaction. Families of patients with cystic fibrosis were found to function very well, with normal mean scores on both standardized profiles. Children with cystic fibrosis showed more behavior problems than expected from the test norms, and healthy siblings of children with cystic fibrosis had behavior problem scores midway between those with the disease and norm scores. Measures of self-concept were remarkably similar for patients and siblings and showed levels at or above those for children and young adults in the general population. Parents psychosocial scores were influenced by the patients' physical parameters, but the severity of the disease generally was unrelated to psychosocial scores of patients and siblings. A notable exception was the correlation of emotional disturbance with amount of hospitalization in patients older than 12 years of age.

Adaptation, Psychological↗
PubMed1985

Family adaptation and psychosocial adjustment to cystic fibrosis in the preschool child.

The parents of 80% (41 of 51) of preschoolers with cystic fibrosis (CF) diagnosed at least 1 year prior to the study and attending the Hospital for Sick Children (HSC) CF Clinic completed the Problem Inventory (PINV), Preschool Behavior Questionnaire (PBQ) and Family Assessment Measure (FAM). The mean age of the CF children was 3.7 years. Parents of a control group of 31 healthy daycare children with a mean age of 3.6 years completed the same questionnaires. Parents of healthy preschoolers reported more child-related problems for 2-5 year olds than did parents of CF children (P less than 0.001) suggesting that parents who have confronted the CF diagnosis go on to minimize the normal stresses of the developmental period. Considerable agreement was seen between PINV scores for mothers and fathers in each group, revealing that parents in a given family perceive similarly the impact their child has upon them. The mean PBQ for CF preschoolers was not significantly different from that of the control group, although there was some tendency toward hostile aggressive behavior in the CF group. Surprisingly, total FAM scores of all samples showed no significant differences with the exception of a better total FAM score for fathers of CF children when compared to control fathers revealing that the CF family is not, during the early years of relative health stability, adversely affected. Two subscales were significantly elevated, social desirability (for CF mothers and fathers) and denial (for CF mothers only), describing an important response style which may enhance mastery of long-term stress.(ABSTRACT TRUNCATED AT 250 WORDS)

Adaptation, Psychological↗
PubMed1984

Comparative pulmonary effects of intraperitoneal inoculation of live v dead Escherichia coli.

We studied the effect of 2.5 X 10(9) live Escherichia coli per kilogram v 2.7 X 10(9) dead E coli per kilogram injected into the peritoneal cavity of sheep with chronic pulmonary lymph fistulas. The effects of dead E coli were compared with those of live E coli, with respect to (1) pulmonary hypertension, (2) hemodynamic failure, (3) damage to the pulmonary microvasculature, (4) systemic arterial hypoxemia, (5) neutropenia and lymphopenia, (6) thrombocytopenia and platelet aggregation, (7) plasma fibrinogen concentration, and (8) classic- and alternative-pathway hemolytic complement. The time after injection of the bacteria was divided into an early period (zero to two hours) and a late period (two to seven hours). We made two conclusions: (1) The early period effects, with the exception of the absolute neutrophil count and Pao2, were independent of bacterial viability, whereas the late period effects were strongly dependent on bacterial viability. (2) The early notable difference between the live v dead groups, with respect to the absolute neutrophil count and Pao2, could not be explained on the basis of an increase in bacterial numbers alone.

Animals↗
PubMed1984

Women's health groups: alternatives to the health care system.

This article describes an empirical study of 28 alternative women's health organizations. These organizations were formed by women who rejected the existing institutions of health care, especially the nature and quality of reproductive health services. The study examined their philosophy of health care, the range of services provided and the characteristics of women who use them, their internal organization in terms of the distribution of power and authority, and the problems and challenges involved in their existence. Implications and impacts resulting from their continuing existence into the 1980s on the delivery of health care for women are addressed.

Community Health Services↗
PubMed1984

Pharmacokinetics of ticarcillin in the horse after intravenous and intramuscular administration.

Serum and peritoneal fluid concentrations of ticarcillin were measured in 10 healthy adult horses from 0.5 to 8 hours after IV or IM administration of 44 mg/kg of body weight. After IV injection, the serum concentration at 30 minutes was 104.3 +/- 6.1 mg/L and the mean peak peritoneal fluid concentration (61.4 +/- 29.0 mg/L) occurred 2 hours after injection. The peak serum (28.3 +/- 5.5 mg/L) and the peak peritoneal fluid concentrations (19.2 +/- 6.0 mg/L) occurred 2 hours after the IM injection. Ticarcillin (greater than or equal to 2 mg/L) persisted in serum and peritoneal fluid for 6 hours after IV injection and 8 hours after IM injection. The half-life of ticarcillin was 0.94 hour after IV injection and the bioavailability of ticarcillin administered IM was 64.9%.

Absorption↗