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R J Simons

Publications and source records attributed to R J Simons.

14 recordsLinked to original sources
PubMed1996

Clinical use of sensitive assays for thyroid-stimulating hormone.

OBJECTIVE: To review the optimal use of sensitive assays for thyroid-stimulating hormone (TSH) by clinicians. METHODS: The available literature pertinent to the clinical application of sensitive TSH testing was identified through a systematic MEDLINE search and reviewed. Selection of materials for inclusion was based on clinical validity of the data and relevance to the study question. SYNOPSIS: Sensitive TSH assays have contributed greatly to our basic knowledge of thyroid physiology and are a powerful clinical tool in the diagnosis and treatment of thyroid disease. The clinical applicability of these assays, as is our understanding of their appropriate use, is rapidly expanding. Based upon the best evidence and current understanding of thyroid physiology, strategies are presented for appropriate use of sensitive TSH assays in healthy outpatients, in patients who are likely to have a disturbed hypothalmic-pituitary-thyroid axis, and in patients on levothyroxane therapy. CONCLUSIONS: Although many clinical questions regarding the use of sensitive TSH assays remain to be studied, it has emerged as a powerful tool for the diagnosis and management of thyroid disease. Optimal use of sensitive TSH assays requires an understanding of TSH physiology and measurement, coupled with appropriate application and interpretation in specific clinical settings.

Humans↗
PubMed1995

Patient attitudes toward medical student participation in a general internal medicine clinic.

OBJECTIVE: To study patient attitudes toward medical students in a faculty academic general internal medicine practice. DESIGN: Survey. SETTING: An academic general internal medicine ambulatory practice site at a university hospital. PATIENTS: Random selection of 199 patients attending the practice; 194 patients completed the survey. MAIN RESULTS: Approximately half (55.8%) of the patients had no preference regarding medical student participation, a third preferred to see the attending physician alone, and 10% preferred to see the student with the physician. Seventy-six percent were not reluctant to disclose "personal" information with the medical student, whereas 24% felt uncomfortable. Almost half (46.5%) of the patients enjoyed their encounters with medical students, 43% were neutral, and 10.3% disliked their encounters. Half of the patients desired some time alone with the attending physician. Thirty-seven percent of the patients reported that they had benefited from their interactions with the medical students. Patients who were men and older appeared to be more receptive of medical students. There was also a trend for patients who had had previous visits involving medical students to be more accepting of their participation. CONCLUSIONS: The majority of the patients in the study were receptive to medical student participation in this ambulatory setting. Patients should be adequately prepared for medical student involvement and each patient should have an opportunity to spend time alone with the attending physician. A sizable minority (a third) of patients do not desire medical student participation.

Adult↗
PubMed1990

Altered immune status in the elderly.

The lung has an array of immunological defenses to protect itself against potentially invasive microorganisms, which include the immunoglobulin-rich alveolar lining fluid, alveolar macrophages, T lymphocytes, and polymorphonuclear neutrophils. Immunosenescence is a major predisposing factor to the increased incidence, morbidity, and mortality of pneumonia in the elderly. The progressive involution of the thymus gland in humans plays a pivotal role in the development of the immunodeficiency state characteristic of the older individual. Age takes its greatest toll on the cell-mediated arm of the immune system. Aged T cells are impaired in their ability to activate and proliferate in response to an antigen. This is partly due to age-associated structural and functional changes within the T cell. In addition, the ability of the T cell to secrete interleukin-2 (a cytokine necessary for the recruitment of other T cells) declines with age. The impaired antibody response of the elderly to foreign antigens, including the pneumococcal polysaccharide and the influenza vaccine, appears to be secondary to a deficiency of T helper cells. The macrophage functions well even in old age, but the recruitment of macrophages by senescent T cells is diminished. There also may be a blunted inflammatory response in the older individual secondary to impaired polymorphonuclear neutrophils chemotaxis and phagocytosis.

Aging↗
PubMed1990

Thyroid dysfunction in elderly hospitalized patients. Effect of age and severity of illness.

To investigate the relative effects of aging and severity of illness on thyroid function as well as the prevalence of thyroid dysfunction in the elderly, we performed thyroid function testing on 190 hospitalized patients 60 years of age or older. Abnormalities of thyroid test results were frequent, and only 27% of patients had normal values for all thyroid function studies. The largest number of patients (125) had a low serum T3 level. Regression analysis showed that severity of illness was a stronger predictor of the T3 level than was age. Our results confirm previous observations that clinical thyroid disease in the hospitalized elderly is not uncommon and often goes unrecognized. Our results also demonstrate for the first time that low concentrations of T3 correlate with a quantitative measure of the severity of illness but only marginally with aging.

Age Factors↗
PubMed1987

Thrombosis of the inferior vena cava in a patient with spinal cord injury.

Thrombosis of the inferior vena cava developed in a 25-year-old man with quadriplegia. The condition occurred six years after his cervical spinal cord injury. The patient had no previous history of thromboembolic disease. Clinical features of inferior vena cava thrombosis were massive bilateral lower extremity edema and dilated superficial abdominal veins. Based on the literature and outcome in this patient, anticoagulants provide the most effective long-term treatment.

Adult↗
PubMed1979

A sensitive gas-chromatographic assay using a nitrogen-phosphorus detector for determination of antipyrine and aminopyrine in biological fluids.

A method using gas chromatography with organic nitrogen-sensitive detection is described for measurement of antipyrine and aminopyrine concentrations in biological fluids. The analysis was performed isothermally on 3% SP-2250 DB after alkalinized saliva was extracted into chloroform. Phenacetin served as internal standard. Low oral doses of antipyrine (1.0-1.8 mg/kg) and/or aminopyrine (2 mg/kg) were measured accurately in saliva of normal human subjects. The standard curves for antipyrine and aminopyrine were linear from 0 to 10 microgram/ml. The coefficient of variation, determined at a salivary concentration of 2 microgram/ml, was 1.7% for antipyrine and 2.4% for aminopyrine. Saliva concentrations obtained by this method in normal human subjects after either an oral dose of antipyrine (18 mg/kg) or aminopyrine (9 mg/kg) agreed closely with those determined by the flame ionization gas-chromatographic method used to measure higher concentrations of antipyrine and aminopyrine. Antipyrine (1.8 mg/kg) administered concomitantly with aminopyrine (1 mg/kg or 2 mg/kg) to normal male volunteers prolonged mean saliva antipyrine half-life by about 25-33% compared to values obtained when these same subjects received the same dose of antipyrine alone.

Adult↗
PubMedDate not supplied

Delirium in the hospitalized elderly.

BACKGROUND: As many as one third of elderly hospitalized patients become delirious, and most do not fully recover. Delirium may impart a higher mortality rate and may be a marker for future cognitive decline. OBJECTIVE: To review the clinical features, etiology, diagnosis, and management of delirium in elderly hospitalized patients. SUMMARY: Delirium can be caused by primary intracranial disease, systemic diseases, withdrawal from alcohol or sedative hypnotic agents, or drug intoxication, the most common cause. Because delirium may present with diverse clinical features, physicians should suspect it in any elderly patient with a change in mental status, personality, or behavior. Bedside screening tools may help distinguish delirium from dementia and psychosis. Causative factors should be sought and removed or treated. Anticholinergic drugs are the worst offenders, but all drugs are suspect and should be discontinued or reduced in dosage. If a sedative is needed, haloperidol is the drug of choice. Because of the prevalence and seriousness of alcohol withdrawal, all delirious patients should receive intravenous thiamine to reduce the risk of Wernicke's encephalopathy. CONCLUSIONS: An organized, systematic approach with early diagnosis and treatment may prove to be life-saving in many patients.

Aged↗