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Biomedical subjects

J L Arnold

Publications and source records attributed to J L Arnold.

At least 19 recordsLinked to original sources
PubMed2004

Impact of an outbreak of severe acute respiratory syndrome on a hospital in Taiwan, ROC.

STUDY OBJECTIVE: To estimate the impact of the severe acute respiratory syndrome (SARS) outbreak in early 2003 on a tertiary care hospital in Taiwan, ROC. METHODS: The study estimated the utilisation of resources related to infection control, SARS related medical services, and routine medical services, and SARS related medical outcomes at National Cheng Kung University Hospital (NCKUH) from 25 March to 16 June 2003 through a cross sectional survey of hospital records. RESULTS: A mean of 5100 persons per day (95%CI 4580 to 5610) underwent fever screening at the outpatient and emergency department (ED) entrances to the hospital, of which 35 per day (95% CI 30 to 40) were referred for further evaluation for suspected or probable SARS. ED isolation surge capacity was created via 12 new beds outside the ED: eight for SARS assessment, three for patients awaiting in hospital bed assignment, and one for resuscitation. A total of 382 patients were fully evaluated for suspected or probable SARS outside the ED, of which 27 were admitted. The mean numbers of outpatient clinic patient visits, ED visits, ED trauma patient visits, ED admissions, hospital admissions, and operative procedures decreased during the outbreak. Thirty eight patients were hospitalised with suspected SARS, of which three received the final diagnosis of probable SARS. Two patients with probable SARS died. No cases of nosocomial SARS transmission occurred. CONCLUSIONS: This SARS outbreak was associated with substantial use of hospital and ED resources aimed at infection control, comparatively less use of resources related to the medical care of patients with suspected or probable SARS, and decreased use of routine medical services.

Bed Occupancy↗
PubMed2001

Emergency medicine in Southern Brazil.

Emergency medicine is developing rapidly in southern Brazil, where elements of both the Franco-German and the Anglo-American models of emergency care are in place, creating a uniquely Brazilian approach to emergency care. Although emergency medical services (EMS) in Brazil have been directly influenced by the French mobile EMS (SAMU) system, with physicians dispatched by ambulances to the scenes of medical emergencies, the first American-style emergency medicine residency training program in Brazil was recently established at the Hospital de Pronto Socorro (HPS) in Porto Alegre. Emergency trauma care appears to be particularly developed in southern Brazil, where advanced trauma life support is widely taught and SAMU delivers sophisticated trauma care en route to trauma centers designated by the state.

Brazil↗
PubMed1999

International emergency medicine and the recent development of emergency medicine worldwide.

Emergency medicine is being established as a unique and independent specialty throughout the world. Two major models of emergency care delivery exist in the world today: the Anglo-American and the Franco-German model. Most countries developing new systems of emergency care are following the Anglo-American model and are recapitulating the sequence of steps taken to establish the systems of emergency medicine in the United States. The most important step in the development of emergency medicine in other countries is the recognition that emergency medicine incorporates a unique body of knowledge requiring specialized practitioners or emergency physicians. A global network of international emergency medicine is assisting the development of emergency medicine worldwide and now includes international organizations, academic institutions, and individuals in countries where emergency medicine is mature and their counterparts in countries where emergency medicine is developing. The multilevel exchange of information through various modalities, such as international conferences, physician exchange programs, and print or electronic media, is playing a vital role in the search for internationally applicable systems of emergency care.

Emergency Medicine↗
PubMed1998

The recent development of emergency medicine in South Korea.

Emergency medicine has developed rapidly in South Korea in the past decade, giving Korea one of the most advanced systems of emergency medical care in Asia. This article reviews the overall health care system and medical climate in Korea, as well as the great progress made in establishing emergency medicine as a specialty. It also describes the many improvements implemented in academic emergency medicine, emergency patient care, and emergency medicine management systems. Although the current economic crisis offers new challenges, much optimism remains about the future of this new Korean specialty.

Delivery of Health Care↗
PubMed1996

Colorectal neoplasms detected colonoscopically in at-risk members of colorectal cancer families stratified by the demonstration of DNA microsatellite instability.

This study compared colonoscopic findings in families meeting the Amsterdam criteria (A) for hereditary non-polyposis colorectal cancer (HNPCC) but stratified according to whether the familial cancers showed DNA microsatellite instability. DNA was extracted from paired samples of normal and cancer, and microsatellite instability was analysed at up to six loci. Families were termed replication error positive (RER+) when at least 50% of tumours tested per family were positive. Of 26 families studied 17 were RER+ and 9 were RER-. Cancers in the A/RER- families showed no right-sided predilection (P < 0.001). Colonoscopies have been performed on 182 at-risk members of A/RER+ families and 60 members of A/RER- families. More of the at-risk members of A/RER-families were found to have adenomas at colonoscopy (P = 0.095), but these were smaller than those of A/RER+ families (P = 0.19). The adenoma:carcinoma ratio was twice as high in A/RER- families (13:1) as in A/RER+ families (7:1). One of the A/RER- families had hyperplastic polyposis. The others do not appear to have attenuated familial adenomatous polyposis and are similar to the adenoma families or late-onset colorectal cancer families described by others. This study illustrates the importance of molecular technology in separating HNPCC from syndromes with overlapping phenotypes.

Adenoma↗
PubMed1995

Erythropoietin levels with treatment of obstructive sleep apnea.

The effect of nasal continuous positive pressure (CPAP) treatment on erythropoietin (EPO) was examined by measuring diurnal serum EPO levels before and twice (over the 3rd day and over 1 day on recall after > or = 1 mo of therapy) after initiation of treatment in 12 obstructive sleep apnea syndrome patients with normal hemoglobin, hematocrit, creatinine, blood urea nitrogen, and albumin levels. Over each study day, oxygen saturation was measured by an ambulatory pulse oximetry system. Patients spent 27 +/- 9% (SE) of time below oxygen saturation of 88% vs. 2.1 +/- 0.6% after initiation of nasal CPAP treatment (P < 0.01). The number of desaturation events per hour of sleep before nasal CPAP treatment was 62 +/- 6 vs. 9 +/- 2 with nasal CPAP (P < 0.01). EPO levels measured by radioimmunoassay were drawn every hour before and at 3 days (n = 9) and before and at recall (n = 0) after initiation of CPAP therapy. The mean serum EPO level was higher before treatment (61 +/- 14 mU/ml) than that at 3 days (38 +/- 10 mU/ml, P < 0.01) or at recall (32 +/- 7 mU/ml, P < 0.01). We conclude that nasal CPAP treatment of sleep-disordered breathing will reduce diurnal levels of EPO.

Adult↗
PubMed1995

Nasal response to carrot and lettuce challenge in allergic patients.

BACKGROUND: Food allergies are usually recognized by historical triggers; yet, on occasion, objective testing may be needed to demonstrate allergic causes more convincingly. OBJECTIVE: Two atopic adult patients presented with respiratory and/or ocular symptoms with an unusual association to handling or eating of vegetables. A third atopic patient presented without attribution of symptoms to vegetable exposure. In all, work-up had revealed positive skin tests and in vitro assays for specific IgE to carrot and/or lettuce; none had gastrointestinal complaints. METHODS: To assess further these unusual histories and/or IgE antibody findings, laboratory challenge was performed with nasal resistance being used as a monitor of rhinitic reaction. RESULTS: The first two patients had prolonged nasal objective responses to challenge; the third had a transient response to one of two challenges. CONCLUSION: We conclude that lettuce and carrot can account for clinically significant IgE-mediated allergic reactions, manifested by nasal obstruction. This laboratory reaction to foodstuffs appears to correlate with patient-reported upper airway and ocular symptoms.

Adult↗
PubMed1993

Arterial oxygen saturation over time and sleep studies in quadriplegic patients.

This study evaluated arterial oxygen saturation (SaO2) over time in a randomly selected group of quadriplegic patients to assess whether clinical history prospectively correlated with profiles of oxygen saturation. In 16 stable male quadriplegic patients (C4-T5), we used pulse oximetry to measure SaO2 over a 24 hour period. Measured values of SaO2 were formatted into a cumulative frequency distribution of SaO2 over time. The cumulative SaO2 values from the quadriplegic patients were compared to SaO2 values in a control group of 12 age-matched healthy male subjects. Ten quadriplegic patients had SaO2 profiles comparable to the range observed in healthy subjects. Six quadriplegic patients had SaO2 profiles outside of the normative range. These 6 exhibited cyclic desaturations (> 4%) during periods of behaviorally-defined sleep, suggestive of sleep-disordered breathing. During wakefulness, however, their values of SaO2 were within the normative range. With respect to level of injury, age, time after injury, or medication use, there was no difference between the six 'hypoxic' quadriplegic patients and the 10 'normoxic' quadriplegic patients. Five of the 6 hypoxic patients had a positive medical history of snoring and increased daytime sleepiness, as compared to 6 of 10 normoxic patients who gave a similar history. We also performed polysomnographic studies in a subgroup of 7 quadriplegic patients. In this subgroup, sleep-disordered breathing was observed in 3 patients (AHI of 54/53/12 per hour, respectively). We conclude that in quadriplegic patients, in whom there is a low clinical suspicion for sleep-disordered breathing, there can occur significant decreases in SaO2 over time.

Adult↗
PubMed1993

Functional electrical stimulation and respiration during sleep.

During obstructive sleep apnea (OSA), respiratory activation of upper airway muscles, particularly genioglossus, is ineffective during sleep. Functional electrical stimulation (FES) of muscles reportedly reduces the number and length of OSAs. Our goals were to examine the effect of FES on sensation during wakefulness and on OSA events. Studies were performed in 11 subjects: 4 healthy asymptomatic subjects and 7 patients with OSA. Surface electrodes placed on the submental region produced discomfort; however, during sleep, the stimulus intensity producing arousal was significantly greater than that producing barely tolerable discomfort during wakefulness. Additionally, we developed a protocol for placement of fine-wire electrodes into the neurovascular bundle of the hypoglossal nerve, using recognizable radiographic features and computerized axial tomography as guides. In these patients, while awake, optimal wire placement was associated with visible tongue protrusion without discomfort. With both surface stimulation and fine-wire FES, during sleep the stimulus intensity required to produce obvious electroencephalographic arousal was significantly greater than that producing a barely tolerable sensation while awake. During apneic events, the application of surface stimulation had an inconsistent effect, terminating 22% of the apneas, and fine-wire FES also had a limited impact, terminating 23% of the apneic events. We conclude from our studies that subjects tolerate surface and fine-wire FES to higher stimulus parameters during sleep than during wakefulness but that both approaches have an inconsistent effect on apneas during sleep.

Adult↗
PubMed1992

Nasal flow-resistive responses to challenge with cold dry air.

Recent studies have suggested that the inhalation of cold air through the nose is associated with the subsequent release of mediators of immediate hypersensitivity. To determine if mucosal surface heat and water loss influence the nasal functional response to cold air, we measured nasal resistance by posterior rhinomanometry before and 1, 5, and 10 min after a 4-min period of isocapnic hyperventilation (30 l/min) through the nose in nine healthy subjects (5 males, 4 females; aged 25-39 yr) while they inhaled air at 0 degrees C. During the challenge period, the subjects breathed either in and out of the nose or in through the nose and out through the mouth. No changes in nasal resistance developed when subjects breathed exclusively through the nose; however, when subjects breathed in through the nose and out through the mouth, nasal resistance was increased 200% at 1 min (P less than 0.01) after the challenge and returned to baseline values by 10 min after cessation of the challenge. These data indicate that nasal functional responses to cold dry air are dependent on the pattern of the ventilatory challenge. If the heat given up from the nasal mucosa to the incoming air is not recovered during expiration (as is the case with inspiration through the nose and expiration through the mouth), nasal obstruction will occur. Hyperpnea of cold air, per se, does not influence nasal resistance.

Adult↗
PubMed1992

Diurnal variations in serum erythropoietin levels in healthy subjects and sleep apnea patients.

We measured arterial oxygen saturation (SaO2) and serum erythropoietin (EPO) levels in patients with obstructive sleep apnea syndrome (OSAS) and in healthy subjects. SaO2 profile was analyzed as the cumulative distribution of SaO2 over time. OSAS patients spent 25.5 +/- 30.9% (SD) of the time at SaO2 of less than 88% vs. 0.64 +/- 1.6% in healthy subjects (P less than 0.05) and had 59 +/- 25 desaturations (greater than 4%) per hour vs. less than 5 per hour in healthy subjects (P less than 0.05). EPO measurements (radioimmunoassay) were made in blood samples withdrawn every 1 or 2 h over a 24-h period. The mean EPO concentration was higher (P less than 0.05) for OSAS patients (45 +/- 33 mU/ml) than for normal subjects (17 +/- 8 mU/ml). There was a significant variability in EPO values over the 24-h period. To analyze the EPO pattern over 24 h, EPO time series were fit to a general cosine function. Data from normal subjects conformed to a cosine function with an amplitude of 3.5 +/- 2.1 (CV of 60%) and an acrophase of 1,000 +/- 184 min after 0800 (CV of 18%), indicating a zenith about 1 A.M. and a nadir around 1 P.M. Data from OSAS subjects fit a similar cosine function with an amplitude of 19.9 +/- 41.0 (CV of 206%) and acrophase of 582 +/- 408 min (CV of 70%), indicating a greater variability in the magnitude and the timing of peak serum EPO levels.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Extended monitoring of oxygen saturation in chronic lung disease.

The goal was to determine values of oxygen saturation from oximetry measurements over extended time periods in the context of prescribing or discontinuing supplemental oxygen. For group 1, when supplemental oxygen therapy was not in use, mean SpO2 values were significantly lower than when it was in use. Without supplemental oxygen, six of eight patients spent greater than 10 percent of the time at or below 88 percent saturation. For group 2, three of the nine patients spent 10 percent of the time at or below 88 percent SpO2. In 16 of 17 patients, lowest room air recorded values of SpO2 were less than 88 percent. We conclude that in many patients with chronic respiratory illness, prolonged monitoring of SpO2 will disclose the presence of hypoxemia. There may be substantial differences in health care cost and outcome depending upon the criteria chosen to prescribe or continue supplemental oxygen.

Adult↗
PubMed1992

The nasal response to exercise in patients with cystic fibrosis.

This study has evaluated the nasal response to exercise in patients with cystic fibrosis (CF), a genetic disease in which factors such as chronic lung disease and/or nasal polyposis might be anticipated to modify nasal function responses. Measurements of nasal resistance (NAR) by posterior rhinomanometry and specific airway resistance (sRAW) were made before and 1, 5, 10, and 30 min after a 4-min period of exhausting legwork exercise (50% predicted maximal) in 19 CF patients (aged 11-29 years) and 10 healthy subjects (aged 11-31 years). One minute after exercise, healthy subjects showed a 54 +/- 5% (mean +/- SEM; standard error of the mean) relative fall from baseline in NAR and CF patients showed a 31 +/- 8% relative fall from baseline (p < 0.05). There were no significant differences in the magnitude or pattern of recovery in NAR after exercise (1 to 30 min) between the groups, largely because of the variability in NAR responses in CF patients. Exercise did not result in significant changes in sRAW in either group. We also found that a history or presence of nasal polyposis does not significantly affect functional nasal responses to exercise. Our conclusion is that the CF genotype and its airway sequelae do not substantively affect the control of the nasal response to exercise.

Adolescent↗
PubMed1992

Serum erythropoietin levels and blood component therapy after autologous bone marrow transplantation: implications for erythropoietin therapy in this setting.

To determine the potential impact of recombinant human erythropoietin (EPO) therapy in patients undergoing autologous bone marrow transplantation (BMT) and colony-stimulating factor therapy, we assayed endogenous serum EPO levels and noted blood transfusion requirements in relapsed non-Hodgkin's lymphoma patients treated with high-dose chemo-radiation therapy and autologous BMT. Hematocrit and reticulocyte counts were determined daily, and hematocrit was maintained in the 25-30% range by transfusion according to criteria established by our hospital transfusion committee. EPO levels were measured by radioimmunoassay and were determined at baseline, throughout therapy, and 2 and 3 months after BMT. Serum EPO levels increased more than 25-fold above baseline in most subjects after initiating chemoradiation therapy. No correlation was noted between serum EPO and hematocrit, reticulocyte count or serum creatinine. Total red blood cell units transfused ranged from 4 to 15 (mean 7.7). Mean total donor exposures (red blood cell plus platelet units transfused) were 83.6 units (range 16-175). Serum EPO levels increased early in the course of preparation for autologous BMT and remained elevated for at least 2-3 weeks thereafter although at a lower level. Red blood cell transfusions were required despite very high EPO levels after BMT. Red cell transfusions, moreover, accounted for only 9.2% (69 of 746) of total donor exposures and only 5.8% (42 of 746) of donor exposures during the interval when pharmacologic doses of erythropoietin might be of benefit. In contrast to the potential benefit of colony-stimulating factors such as G-CSF and GM-CSF in BMT, our study suggests limited value for erythropoietin therapy in this setting.

Adult↗
PubMed1990

Occupational allergic rhinitis in the hair care industry: reactions to permanent wave solutions.

This report details our observations on rhinitic reactions in nonatopic professional beauticians in whom an etiologic agent for occupational symptoms was not previously determined. Exposure to permanent wave solutions in a laboratory setting caused clinical symptoms and significant laboratory evidence of nasal airway obstruction. In one patient, previous treatment with cromolyn sodium reduced, but did not completely eliminate, the reaction.

Adult↗
PubMed1989

Occupational allergic rhinitis reaction to psyllium.

We report studies that document a specific rhinitic reaction that developed as a result of occupational exposure to a psyllium-based powdered laxative. This nurse had a nonatopic family history, personal evidence of atopy (skin test reactions to pollen, cat dander, and house dust), and a significant elevation of antipsyllium IgE. Measurements of nasal and lower airway resistance documented only nasal obstruction to brief inhalational challenge to the laxative. Symptomatic relief was achieved with prior treatment with cromolyn. We suggest that nasal airway challenge can document and assess treatment for occupational rhinitis.

Airway Resistance↗