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Biomedical subjects

M R Simon

Publications and source records attributed to M R Simon.

At least 19 recordsLinked to original sources
PubMed2001

Atypical expiratory flow volume curve in an asthmatic patient with vocal cord dysfunction.

BACKGROUND: Vocal cord dysfunction can coexist with or masquerade as asthma. Vocal cord dysfunction, when coexistent with asthma, contributes substantially to the refractory nature of the respiratory problem. OBJECTIVE: To report a case of an asthmatic patient with vocal cord dysfunction and a previously unreported unique expiratory flow volume curve. RESULTS: A 16-year-old female, known to have asthma, developed increased frequency of her asthma exacerbations. Spirometry, during symptoms, showed an extrathoracic airway obstruction with a reproducible unique abrupt drop and rise in the expiratory flow volume loop. Laryngoscopy showed adduction of the vocal cords during inspiration and expiration. CONCLUSIONS: We report a unique expiratory flow volume curve in an asthmatic with vocal cord dysfunction that resolved with panting maneuvers. Speech and psychological counseling helped prevent future attacks.

Adolescent↗
PubMed2001

Wheezing and vocal cord dysfunction mimicking asthma.

Vocal cord dysfunction (VCD) is a respiratory disorder characterized by paradoxical closure of the vocal cords during the respiratory cycle leading to obstructive airway symptoms. The presenting symptoms vary from stridor to wheezing. VCD may coexist with asthma or masquerade as asthma. Misdiagnosis of VCD as asthma leads to inappropriate use of systemic steroids with its adverse effects, frequent emergency department visits, hospitalization, and, rarely, intubation and tracheostomy. Attenuation of the inspiratory flow volume loop on spirometry is suggestive of VCD. Laryngoscopic demonstration of the paradoxical vocal cord movements during an acute attack is the gold standard for the diagnosis of VCD. Patient education, speech therapy, and psychologic counseling are the therapeutic tools for treatment.

Acute Disease↗
PubMed1998

Patient satisfaction with psychiatric treatment of menopausal women in a multidisciplinary women's midlife center.

OBJECTIVE: Menopause may be associated with new onset psychiatric symptoms or may exacerbate or heighten preexisting psychiatric problems in women. We present a model center for midlife women, with a multidisciplinary approach to treating this population, and patients' perceptions of satisfaction with treatment received during referral visits to an outpatient psychiatry clinic. DESIGN: In this study, 59 patients were referred from their primary care provider at the midlife center for evaluation by a faculty psychiatrist in an outpatient setting. A brief telephone interview was administered within 1 year of initial evaluation, using items from the Client Satisfaction Questionnaire-8 (CSQ-8) to assess patient satisfaction with psychiatric services received during the referral visits. Findings were based on responses provided by 50 women who were successfully contacted by telephone for the follow-up assessment. RESULTS: For this sample, the mean total client satisfaction score was 27.8 (s = 5.4) of a possible score of 32, which indicated that most women who were referred for psychiatric services reported a positive experience with the services provided by outpatient psychiatrists and reported being very satisfied with their treatment. CONCLUSIONS: We feel that this model center represents a unique way to identify and treat psychiatric disorders in a patient population that may be at high risk for depression and other psychiatric disorders.

Adult↗
PubMed1997

Esophageal candidiasis as a complication of inhaled corticosteroids.

BACKGROUND: Oropharyngeal candidiasis is a well-described side effect of inhaled corticosteroids. Nevertheless, few cases of esophageal candidiasis have been reported. OBJECTIVE: To present a patient with esophageal candidiasis associated with inhaled corticosteroids. METHODS: Case report. RESULTS: Our patient is a 70-year-old white woman with a 20-year history of intrinsic asthma, well controlled on triamcinolone acetonide 400 micrograms, ipratropium bromide 36 micrograms, and pirbuterol acetate 400 micrograms, each inhaled four times daily. She reported no oral steroid use for > 4 years and that she always rinsed her mouth following triamcinolone acetonide inhalation. The patient had gastritis with peptic ulcer disease in the past and developed worsening dyspeptic pain and heartburn. Following discontinuation of cimetidine and initiation of ranitidine without improvement, esophagogastroduodenoscopy was performed. Several small white patches in the mid and distal esophagus could not be removed with pressure. A biopsy confirmed the diagnosis of candidal esophagitis. Following a 4-week course of fluconazole, the patient was clinically improved and follow-up esophagogastroduodenoscopy was normal. There was no evidence of underlying cellular immunosuppression, malignancy, or diabetes mellitus and no history of recent antibiotic usage. Delayed skin tests revealed 5 x 5 mm induration to dermatophytin. Delayed hypersensitivity to Candida and mumps tests was absent. There was strong in vitro lymphocyte transformation and a positive immediate skin test response to Candida. ELISA for human immunodeficiency virus was negative. T and B cell counts were normal with CD4 = 630/mm3, CD8 = 520/mm3, and absolute B cell = 120/mm3. It is possible that this patient's immediate hypersensitivity response to Candida suppressed her delayed response. Candidal esophagitis is a rare, yet important, complication of inhaled corticosteroid use. CONCLUSION: Immunocompetent patients on inhaled corticosteroids with medically unresponsive symptoms of esophagitis should be investigated for esophageal candidiasis.

Administration, Inhalation↗
PubMed1996

Clozapine-induced urinary incontinence: incidence and treatment with ephedrine.

BACKGROUND: Treatment with the atypical antipsychotic drug clozapine appears to be associated with an increased incidence of urinary incontinence (UI). We posited that the potent anti-alpha-adrenergic effects of clozapine were involved, and hence that an alpha-adrenergic agonist would reduce UI. We tested this hypothesis by using ephedrine, an approved alpha-adrenergic agonist. METHOD: Fifty-seven inpatients with schizophrenia or schizoaffective disorder (DSM-IV) who met the Kane criteria for being treatment refractory were treated with clozapine (75-900 mg/day). Patients who developed UI were then openly treated with ephedrine in increasing doses until UI was attenuated or a dose of 150 mg/day was attained. RESULTS: Seventeen patients developed UI as evidenced by either urine-stained sheets/clothing or direct patient reports. In 2 cases, the UI was sufficiently severe that adult diapers had to be used. Comparison of patients who developed UI and those who did not showed that UI was associated with female gender and with concomitant treatment with typical antipsychotic drugs. One patient was treated with a behavioral program, but the remaining 16 patients were treated with ephedrine. Ephedrine treatment was very effective, with 15/16 patients showing improvement within 24 hours after reaching maximum ephedrine dosage. Twelve of 16 (including the 2 most severe) eventually had a complete remission of their UI. In the remaining 4 patients, 3 had a reduction in the frequency of UI and 1 showed no response. These benefits have been maintained over the course of 12 months of subsequent treatment for several patients. There were no side effects associated with the use of ephedrine nor were there any changes in neuropsychiatric status. CONCLUSION: Ephedrine appears to be a safe and effective treatment clozapine-associated UI. By inference, it is likely that clozapine may cause UI via its anti-alpha-adrenergic properties.

Adrenergic alpha-Agonists↗
PubMed1995

Antigen presenting cell-independent cytokine and spontaneous in vitro IgE production in patients with atopic dermatitis: increased interferon-gamma production and lack of effects of in vivo low-dose interferon-gamma treatment.

Atopic dermatitis is characterized by elevated serum IgE concentrations and dysregulation of T-lymphocyte function. To examine the pattern of cytokine production associated with elevated IgE levels, phorbol ester plus ionomycin-stimulated production of interleukin (IL)-4, IL-5, and interferon-gamma (IFN-gamma) by blood mononuclear cells from 16 patients with atopic dermatitis was compared with that of 18 healthy subjects. Spontaneous in vitro IgE production was also studied longitudinally in patients receiving placebo or daily treatment with 0.05 mg/m2 IFN-gamma. Spontaneous in vitro IgE production and mitogen-driven IL-4 and IFN-gamma synthesis did not differ when patients were receiving interferon treatment compared with no treatment. Furthermore, ionomycin plus phorbol ester-stimulated mononuclear cells from patients with atopic dermatitis produced less IL-4 and more IFN-gamma than did cells from healthy subjects. IL-5 production by cells from patients with atopic dermatitis did not differ from that of cells from healthy subjects. The ratio of IL-4 to IFN-gamma produced in vitro was significantly lower (p = 0.04) in the cells of patients with atopic dermatitis (0.9) as compared with those of healthy subjects (2.7). The findings suggest that when circulating T cells are stimulated under antigen presenting cell-independent conditions, atopic dermatitis is not characterized by the shift in the reciprocal relationship between IL-4 and IFN-gamma production, which has been postulated to explain the pathogenesis of IgE elevation and the therapeutic action of IFN-gamma in patients with atopic dermatitis.

Adult↗
PubMed1995

Allergic-type adverse reactions to low osmolality contrast media in patients with a history of allergy or asthma.

RATIONALE AND OBJECTIVES: The author evaluated the hypothesis that the incidence of allergic-type adverse events among atopic and asthmatic cardiac angiography patients would be lower in patients randomized to receive nonionic versus ionic lower osmolal contrast medium. METHODS: Enrollment criteria included a history of food allergy, asthma, atopic dermatitis or pollinosis but not prior contrast media-induced adverse events. One hundred forty-two patients enrolled were randomized to receive either the ionic agent ioxaglate or nonionic iopamidol. Patients and investigators were masked. Sixty-eight patients received iopamidol, and 74 received ioxaglate. Group means were compared using the unpaired Student's t test. Contingency tables were analyzed using chi-square or Fisher's exact test. RESULTS: Allergic-type adverse events (excluding flushing, warmth, and cardiac events) were recorded in 8 of 68 patients in the iopamidol group versus 19 of 74 in the ioxaglate group. Ioxaglate was more likely to be associated with a reaction than iopamidol (P < 0.05, chi-square test). Iopamidol was more likely to be associated with flushing when considered independently (38 of 68) than use ioxaglate (24 of 74)(P < 0.005, chi-square test). There was no difference in the incidence of cardiac events, or any combination of allergic-type adverse events, cardiac events, and flushing in patients who received iopamidol or ioxaglate. CONCLUSION: In this double-masked study, iopamidol caused fewer allergic-type adverse events (excluding flushing and cardiac events) but more flushing than ioxaglate in patients with a history of asthma or atopic disease. When cardiac events also were considered, there was no difference in the incidence of reactions after iopamidol and ioxaglate.

Asthma↗
PubMed1994

Elevated serum tryptase levels in a patient with protracted anaphylaxis.

BACKGROUND: Anaphylactic reactions usually occur seconds to minutes after exposure to the relevant antigen. Late onset, biphasic, and protracted anaphylaxis also occur. The incidence of prolonged responses is unknown, but may be common. In all nonfood-related cases, levels of tryptase were not measured during protracted episodes. Tryptase has been shown to be a useful specific indicator of mast cell involvement in anaphylaxis. OBJECTIVE: To determine whether mast cell activation, as demonstrated by elevated serum tryptase concentrations, can occur in protracted anaphylaxis. METHODS: Case report; serum tryptase concentrations were measured by radioimmunoassay. RESULTS: A 33-year-old white man developed hives three days prior to admission. The next day, vomiting, abdominal cramps and bloating, lower lip swelling, wheezing, and a feeling of tightness over his throat and chest were experienced. The gastrointestinal symptoms continued until his hospital admission. One day prior to admission, he developed transient lightheadedness. On admission he had generalized urticaria and abdominal tenderness. Blood pressure of 115/58 mm/Hg rose to 180/60 and heart rate fell from 107/min to 90/min following 2.2 L of intravenous fluids. Serum tryptase levels were elevated at 7.2 ng/mL and 5.1 ng/mL on the first and second hospital days (fourth and fifth days of symptoms). Serum tryptase was < 1.0 ng/mL 5 months later. CONCLUSIONS: The elevated serum tryptase levels at 96 and 120 hours following the onset of symptoms strongly suggest that continued mast cell degranulation can occur during protracted anaphylaxis. This strengthens the argument that mast cell activation is important in the pathophysiology of protracted anaphylaxis.

Adult↗
PubMed1991

Angiotensin II augmentation of tyrosine kinase activity in human adherent mononuclear cells.

The relationship of angiotensin converting enzyme activity and angiotensin II to the inflammatory process in diseases such as sarcoidosis remains unclear. We hypothesize that granuloma macrophages regulate inflammation by release of angiotensin converting enzyme, which produces angiotensin II, and that angiotensin II in turn modulates monocyte/macrophage activity. Since tyrosine kinase catalyzes phosphorylation of tyrosine residues in proteins and is important in signal transduction and cellular activation, we further postulated that monocyte tyrosine kinases may play a role in the regulation of this process. Mononuclear cells from 11 healthy subjects were assayed for tyrosine kinase activity in the presence and absence of angiotensin II. In addition, tyrosine-specific phosphorylation of cellular proteins was also determined. Angiotensin II increased tyrosine kinase activity in a concentration-dependent manner. The maximal stimulation, which varied from 31 to 506%, was achieved following incubation of cells with 10(-4) M angiotensin II. Angiotensin II also increased the tyrosyl-phosphorylation of three proteins with molecular weights of 57, 62, and 63 kDa. We conclude that tyrosine kinase activity of adherent mononuclear cells and tyrosine phosphorylation of certain protein(s) may be involved in angiotensin II regulation of inflammatory processes.

Angiotensin II↗
PubMed1989

Angiotensin II binding to human mononuclear cells.

Serum angiotensin converting enzyme activity is elevated in certain human granulomatous diseases. Angiotensin II modestly suppresses thymidine incorporation and augments gamma interferon production from human blood mononuclear cells. This suggests that angiotensin II may play an immunoregulatory role in human granulomatous inflammation. For this reason, the binding of angiotensin II to human peripheral blood mixed mononuclear cells, and to the human monocyte-like cell line, U-937, was studied. Angiotensin II binding to U-937 cells reveals a low level of saturable specific binding (Kd = 3 x 10(-10) M). However, binding to human cells is not easily reversible and is poorly inhibited in a competitive manner. In addition, the molecular integrity of the radioligand is not maintained following binding. Therefore, the definition of classical receptor binding cannot be fulfilled. Since binding is decreased by low temperatures and various metabolic inhibitors, it appears likely that endocytosis occurs, perhaps along with receptor binding. Angiotensin II or its breakdown products modulate the production of monocyte cAMP in spite of the inability to demonstrate classical cell surface receptors.

Angiotensin II↗
PubMed1989

Anaphylaxis associated with relative bradycardia.

A 31-year-old man with allergic rhinoconjunctivitis and asthma experienced an episode of anaphylaxis following an injection of allergens during hyposensitization. His anaphylactic episode was remarkable because of a relative sinus bradycardia at the beginning of his reaction. This case is reported to highlight the importance of not confusing the anaphylactic syndrome with vasovagal syncope even when a tachycardia is initially absent. The possible pathophysiologic role of right coronary vasospasm resulting in the Bezold-Jarish reflex or sinoatrial node ischemia is discussed.

Adult↗
PubMed1988

Cellular heterogeneity and insulin-like growth factor I immunoreactivity among epiphysial growth plate chondrocytes in the pig.

The localization of insulin-like growth factor I (IGF-I, also called somatomedin C) production in porcine epiphysial growth plates of the distal humerus was studied by immunohistochemistry. Counterstaining with Alcian blue-van Gieson demonstrated two cell types (blue and red cells) in the germinal (reserve), proliferating and hypertrophic zones; only those chondrocytes of the proliferative and hypertrophic zones that stained red were also immunoreactive to the antibody to IGF-I. The results indicate that there exists a functional heterogeneity among the chondrocytes of both the proliferative and hypertrophic zones of growth cartilage and that IGF-I is locally produced in only the red cells of these zones. Because the red cells of the germinal zone were not immunoreactive, the results suggest that the red cells of the germinal zone and the red cells of the proliferative and hypertrophic zones are also functionally distinct.

Animals↗
PubMed1988

Multimodality evoked potentials in sarcoidosis.

Neurosarcoidosis is suspected on clinical grounds and then confirmed by radiography, by spinal fluid examination, or by biopsy. To determine whether evoked potential testing may also be of value in diagnosing and following the course of neurosarcoidosis, multimodality evoked potentials were obtained in 12 men with sarcoidosis, including two with neurosarcoidosis. Seven of 12 subjects, one of whom had neurosarcoidosis, manifested abnormal evoked potentials. Visual evoked potentials were abnormal in one patient and somatosensory evoked potentials were abnormal in one patient. Five additional patients, including one with neurosarcoidosis, had abnormal auditory evoked potentials suggestive of auditory nerve or low pons involvement. These data indicate that multimodality evoked potentials, especially auditory potentials, may show central nervous system involvement in patients with sarcoidosis in the absence of clinically apparent disease.

Adrenal Cortex Hormones↗
PubMed1987

Multimodality evoked response testing in sarcoidosis.

Neurosarcoidosis is suspected on clinical grounds. The diagnosis is confirmed radiographically or by spinal fluid examination or biopsy. Evoked response testing in sarcoidosis has been studied by three groups of investigators. Visual, somatosensory, or brainstem auditory evoked potentials were abnormal in some sarcoidosis patients with, and in others without clinical evidence of neurological involvement. Multimodality evoked response testing may be useful in further defining neurosarcoidosis and in detecting subclinical disease.

Evoked Potentials↗
PubMed1986

T-cell differentiation antigens and antigenic lymphocyte reactivity in pleural effusions.

Blood and pleural effusion mononuclear cells from thirteen patients were examined for the expression of T lymphocyte differentiation antigens as well as in vitro thymidine incorporation. The ratio of T4 to T8 cells was significantly greater among pleural effusion lymphocytes than among blood lymphocytes. Effusion lymphocyte responses to phytohaemagglutinin were less than those of blood lymphocytes. Unstimulated thymidine incorporation was greater in pleural effusion lymphocytes. Antigen-stimulated lymphocyte reactivity was not consistently greater in either blood or effusion lymphocytes. Lymphocytes from tuberculous effusions all reacted to tuberculin. Pleural effusion lymphocytes, regardless of the etiology of the effusion, possessed the same range of antigenic specificities as did blood lymphocytes. Therefore, effusion lymphocyte responsiveness to tuberculin does not prove the presence of tuberculous pleurisy but does indicate sensitisation to tuberculin.

Adult↗