23rd Annual International Symposium
on
Man and His Environment in Health and Disease
Special Focus
The Autonomic Nervous System and Its
Relationship to Environmental Pollutants Including the Cardiovascular System
and Electromagnetic Sensitivity
Sponsored by
American Environmental Health Foundation
and
University of
Physician
Accreditation/Credit:
This activity has been planned and implemented in
accordance with the Essential Areas and policies of the Accreditation Council
for Continuing Medical Education through the joint sponsorship of the
University of North Texas Health Science Center at Fort Worth Office of
Professional & Continuing Education and the American Environmental Health
Foundation. The University of North Texas Health Science Center at Fort Worth
Office of Professional & Continuing Education is accredited by the ACCME to
provide continuing medical education for physicians.
The University of North Texas
Health Science Center at
The University of North Texas
Health Science Center at
The University of North Texas Health Science Center
anticipates this program for 24 hours in Category 2A CME credit hours, pending
approval from the American Osteopathic Association.
Nursing
Accreditation/Credit:
To receive a certificate of successful completion,
participants must attend the activity in its entirety and complete and return the
activity evaluation credit request form.
Reprints are available from American Environmental
Health Foundation. This volume is not to be reproduced, all or in part, without
the written permission of American Environmental Health Foundation.
FINANCIAL CONSIDERATION
AEHF is a nonprofit organization that was founded in 1975 to provide education and research into Environmental Medicine. This year’s Symposium is our 23rd Annual International Symposium and is our major vehicle for educating the medical professional.
Funding for the symposium is provided by registration fees from physicians and exhibitors. Proceeds from the AEHF store cover the shortfall between registration fees and expenses for the conference. AEHF does not receive grants or any outside financial support for our education. Donations are accepted and used toward research into environmental medicine.
INTRODUCTION
SYMPOSIUM PURPOSE
Since 1981, the
International Symposium has been recognized as one of the most advanced medical
forums in the world addressing the research and treatment of environmental
effects on health and disease. The 2005 conference will focus on “The Autonomic
Nervous System and Its Relationship to Environmental Pollutants Including the
Cardiovascular System and Electromagnetic Sensitivity”. This Conference
presents the most current information available while providing guidelines to
identify, diagnose, treat and to prevent environmentally triggered responses in
the body.
GOALS OF THE MEETING
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To provide new insights in The
Autonomic Nervous System and Its Relationship to Environmental Pollutants
and the environmental causes behind many problems you see.
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To present new diagnostic and treatment modalities to help you improve
the quality of care for your complex patients.
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To provide concepts, tools that will enhance your practice.
OBJECTIVES OF THE MEETING
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Improve the outcome of treating patients with sensitivities to The Autonomic Nervous System and Its
Relationship to Environmental Pollutants.
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Use new concepts and treatments to help better diagnose and manage many
patients with environmentally triggered problems and sensitivities to The Autonomic Nervous System and Its
Relationship to Environmental Pollutants.
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Apply the concepts of this conference to your practice by using
nutrition and environmental manipulation for the treatment of sensitivities to The Autonomic Nervous System and Its
Relationship to Environmental Pollutants.
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Use the information presented to enhance the effectiveness, cost-efficiency,
and competitiveness of the physician in relation to The Autonomic Nervous System and Its Relationship to Environmental
Pollutants.
INTENDED AUDIENCE
M.D.=s, D.O.=s, medical students, nurses,
nutritionists and other health professionals interested in the concepts and
practice of Environmental Medicine, Occupational Medicine and Toxicology.
EDUCATIONAL FORMATS
#
Plenary
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Panels Discussions
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Case Studies
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Question & Answer Sessions.
CONFERENCE FORMAT
The AEHF Committee has
selected some of the leading experts in the fields of chronic disease,
nutrition and chemical sensitivity.
Each speaker=s presentation will last
approximately 20 minutes and will be followed by a 10 minute question and answer
session. All speakers are encouraged to use any and all appropriate
audio/visual aids. (A brief outline of the speech is included in this booklet.)
GIVEN IN COOPERATION
William J. Rea, M.D.,
F.A.C.S.
Symposium
Chairman,
American
Environmental Health Foundation,
Environmental
Bertie B. Griffiths, Ph.D.,
Environmental
Kaye H. Kilburn, M. D.
University
of Southern
William J. Meggs, M.D., Ph.D.
Brody
Department of Emergency Medicine
23rd ANNUAL INTERNATIONAL SYMPOSIUM
ON MAN & HIS ENVIRONMENT
Alexander
Riftine, Ph.D.
"POTS – Autonomic
Dysregulation and Mineral Deficiencies", Kalpana Patel, M.D.
Freddy
Abi-Samra, M.D.
“Autonomic Nervous System Environmental Pollutants and
the Inner Ear”
ABSTRACTS
AND
HANDOUTS
Objectives & Notes
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Doug
Seba, Ph.D. |
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Phone: 703/949-1055 |
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Training: |
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Current Job Description: |
Independent Marine Scientist |
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Other Information: |
40 years experience with chemicals and the environment. |
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SPEECH TITLE: “Environmental Update 2005: Chemicals, Nerves and Electromagnetism” At the end of this Presentation, the participant should be able to: 1. To understand the connection between environmental stressors, particularly electromagnetic and xenobiotic chemicals, and adverse neurological processes. 2. To realize that such adverse health effects can occur at great distances in time and place from their environmental origin making diagnosis and treatment difficult. 3. References drawn from a mix of media, websites, and scientific publications relevant to the current timeline. The above information was provided by the
Speaker. |
ENVIRONMENTAL UPDATE 2005:
CHEMICALS, NERVES AND
ELECTROMAGNETISM
Douglas B. Seba
Dysfunction of the
autonomic nervous system is quintessentially the definition of the typical
environmental illness patient. Simply put, in almost all cases of environmental
illness, whether from chemical, physical, or biological sources, or a
combination of them, nervous system symptoms are a keystone in both diagnosis
and treatment of the patient. This Conference rightly acknowledges this
relationship and draws focus to environmental pollutants, a theme of 23 years,
because it is a root cause of environmental illness and unfortunately,
pollution endures. In particular, this Conference will examine the effects of
environmental pollutants on the neurological processes of the cardiovascular
system, reflecting a principle interest of the AEHF, with special emphasis on
one of the most insidious physical pollutants, electromagnetism.
Often called electronic
smog in contemporary literature, mankind is being exposure to far more
electromagnetic pollution than in any time in our planets history. Like
chemicals, electromagnetism appears to have two sides. On one hand, a study
shows two-fold risk increase of acoustic neuromas from cell phone use, while
another study shows repetitive transcranial magnetic stimulation to improve
mental focus. Both studies demonstrate that electromagnetism exposure has
health effects. Just like chemicals and biologicals which have become pervasive
in our environment, and often have adverse effects at great distances in time and
location from their origins, so too, do electromagnetics. Outside of living in
a Faraday cage, a patient and his or her heart are exposed to electromagnetic
smog from things as close as their toaster and as distant as satellites or sun
spots.
This is a general review
to set the tone for the Conference. Highly selected examples will be drawn from
a mix of media, website, and scientific publications relevant to the current
timeline. Some examples of electromagnetic processes will be personally applied
by the reviewer to ongoing research in wildlife anomalies in the Bitterroot
mountains of Montana and the incursion of African dust storms into the Western
hemisphere.
Objectives & Notes
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Amer
Suleman, M.D. |
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The Heartbeat Clinic |
Phone: 214/504-9942 |
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Fax: 214/544-7556 |
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Email: [email protected] |
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Training: |
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Current Job Description: |
Private Practice in Electrophysiology |
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SUNY
at |
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Residency: |
SUNY
at |
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Board Certifications: |
Electrophysiology; Cardiology; Internal Medicine |
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SPEECH TITLE: “Dysautonomias and Dysrhythmias” At the end of this Presentation, the participant should be able to: 1. Understand interaction of autonomic nervous system with arrhythmias. 2. Understand Physiology of autonomic nervous system. 3. Understand role of management options for common arrhythmias. The above information was provided by the
Speaker. |
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Objectives & Notes
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William J.
Rea, M.D., FACS |
Date
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Environmental |
Phone: 214/368-4132 |
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Fax: 214/691-8432 |
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Email: [email protected] |
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Training: |
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Current Job Description: |
M.D.,
President – Environmental |
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Current Faculty Appointments: |
Professor
of Medicine, |
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Internship: |
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Residency: |
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Board Certifications: |
American Board of Surgery; American Board of Thoracic Surgery; American Board of Environmental Medicine |
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Other Information: |
“Optimum Environments for Optimum Health and Creativity” |
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SPEECH TITLE: “Autonomic Nervous System Response in 100 Chemically Sensitive Patients” At the end of this Presentation, the participant should be able to: 1. Be able to identify ANS dysfunction clinically 2. Be able to identify ANS dysfunction by laboratory 3. Be able to use this knowledge in their practice. The above information was provided by the
Speaker. |
Objectives & Notes
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Javier
Santos, M.D. |
Date
of talk: |
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Hospital General Valle
Hebron Institut Fundacio
Recerca, Digestive Diseases Research Unit Paseo Valle Hebron
119-129 Barcelona, Barcelona
08035 |
Phone: 93/489-4035 |
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Fax: 93/489-4456 |
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Email: [email protected] |
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Training: |
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Current Job Description: |
Principal
Investigator, Digestive Diseases Research Unit, Hospital Valle de Hebron, |
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Internship: |
Hospital Valle de Hebron, Barcelona,
Spain |
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Residency: |
Hospital Valle de Hebron, Barcelona,
Spain |
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Board Certifications: |
Not applicable |
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SPEECH TITLE: “Autonomic Innervation of Gut Mucosa-Associated Lymphoid Tissue” At the end of this Presentation, the participant should be able to: 1. To understand that immune and nervous systems display a dynamic and interactive communication based upon the presence of common messengers and receptors. 2. This interaction is functionally relevant and may have important clinical implications. 3. Modulation of nerve-immune interactions in the gastrointestinal and respiratory tracts may influence the course of hypersensitivity and inflammatory disorders. Development of new drugs with blocking or enhancing activity against nerve-immune mediators and receptors may contribute to the prevention and treatment of these disorders. The above information was provided by the
Speaker. |
Autonomic innervation of Gut-Mucosa-Associated Lymphoid tissue. Javier Santos, M.D., Ph.D. Hospital Universitario Valle de
Hebron. Digestive System Research Unit.
Goals
and Objectives
1. To understand that immune and
nervous systems display a dynamic and interactive communication based upon the
presence of common messengers and receptors.
2. This interaction is functionally
relevant and may have important clinical implications.
3. Modulation of nerve-immune
interactions in the gastrointestinal and respiratory tracts may influence the
course of hypersensitivity and inflammatory disorders. Development of new drugs
with blocking or enhancing activity against nerve-immune mediators and
receptors may contribute to the prevention and treatment of these disorders.
Outline
The mucosal surfaces of the body are the first and critical location where immunogenic particles and molecules (food and microorganism-derived antigens) gain access to the immune system. Antigen processing in this region will determine whether an immunological balanced or unbalanced response (anaphylactic reaction) or a permissive one (tolerance) is mounted. Mucosal membranes are covered by epithelial layers. In the gastrointestinal and respiratory systems, classical effector cells of immune reactions (lymphocytes, eosinophils, mast cells, neutrophils, macrophages and dendritic cells) are normally present. Non-traditional immune cells, including epithelial, mesenchymal (fibroblasts, myofibroblasts, muscle cells), endothelial and nerve cells and also acellular components such as the extracellular matrix may also display potentially relevant effector and modulatory functions in antigen processing and immunologic responses. In addition, food itself may be also immunomodulatory.
Our knowledge of the immunoregulatory effects of nerves and neuropeptides has grown tremendously. Considerable and converging evidence has now established the existence of multidirectional communication between the neural and immune systems. This interaction involves most immune cells present in mucosal surfaces, and both the central and peripheral nervous systems, including efferent and afferent subdivisions of the autonomic nervous system, sympathetic and parasympathetic, as well as the enteric nervous system. Moreover, those studies have shown the functional relevance of neuro-immune interactions in regulating immunological and inflammatory events in mucosal surfaces, by influencing the transport of macromolecules across the epithelial surface, the expression of adhesion molecules, the release of cytokines, chemokines, neurotransmitters, neuropeptides, and other regulatory molecules that participate in the trafficking and homing of immune cells in the mucosal layers, the growth and remodeling of nerves, and even the apoptotic cascade. A good clinical correlate are food-allergic reactions that may display a broad spectrum of clinical manifestations involving most tissues in the body, although it is generally accepted that primary events predominantly occur at the level of the gastrointestinal mucosa.
A distinct characteristic of the complex neuroendocrine and immune systems is the high level of integration of both systems which together provide the organism with an ultra-fine homeostatic balance. The neuroendocrine system modulates the function of the immune system through the release of neuropeptides, neurohormones and neurotransmitters. In addition, a primary or counteracting immunoregulatory role for immune cells has also been reported which comprises the effects of mediators released by immunocompetent cells on neuroendocrine function. It is now clear that immune cells are able to synthesize and release neuropeptides and even classical hormones such as growth hormone or prolactin, and that endocrine and neural cells can produce a broad array a cytokines originally described as being part of the repertoire of immune cells. This conference will focus mainly on the efferent limb of the neuro-immune interactions, that is the effect of neural mediators on immune cells, particularly lymphocytes and mast cells. For this purpose anatomical and functional evidence for the presence and relevance of neural and neuropeptide-containing fibers in lymphoid tissues and immunocompetent cells will be reviewed. Finally, experimental and clinical data supporting the potential relevance of this interplay and its significance in the management of food allergy and other inflammatory disorders will be briefly exposed.
Conclusions
Central
and peripheral nervous system manipulation by psychological (hypnosis,
behavioral conditioning),
pharmacological and other modalities of intervention could turn out to be as
very valuable weapons against the deleterious effects of environmental
stressors on the immune system. In particular, increasing awareness of the
major role of gastrointestinal inflammation in the development of local and
systemic adverse reactions to food, microbial and chemical components may open
new avenues in the treatment and prevention of environmental-related
inflammatory disorders.
References
1.Santos J, Bienenstock J, Perdue MH. Innervation of
lymphoid tissue and functional consequences of neurotransmitter and
neuropeptide release. In: Brostoff J, Challacombe SJ, eds. Food Allergy and Intolerance, 2nd ed. W.B. Saunders,
2.Felten DL, Felten SY, Carlson SL,
Olschowska JA, Livnat S. Innervation of lymphoid tissue. J
Immunol 1985; 135: 755s-765s.
3.Madden KS, Felten DL. Experimental
basis for neural-immune interactions. Physiol Rev
1996; 75: 77-106.
4.Straub RH & Besedovsky HO. Integrated evolutionary, immunological, and
neuroendocrine framework for the pathogenesis of chronic disabling inflammatory
diseases. FASEB J 2003; 17:2176–2183.
5.Elenkov I Chrousos GP. Stress
Hormones, Proinflammatory and Antiinflammatory Cytokines, and Autoimmunity. Ann
NY Acad Sci.2002; 966: 290-303.
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Objectives & Notes
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Kalpana
Patel, M.D. |
Date
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Allergy and Environmental |
Phone: 716/833-2213 |
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Fax: 716/833-2244 |
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Training: |
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Current Job Description: |
President of EHC-Buffalo, President of American Board of Environmental Medicine |
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Current Faculty Appointments: |
Asst.
Professor of Pediatrics at SUNY |
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Internship: |
Pediatrics |
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Residency: |
Pediatrics |
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Board Certifications: |
Pediatrics/Environmental Medicine |
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SPEECH TITLE: “POTS – Autonomic Dysregulation and Mineral Deficiencies” At the end of this Presentation, the participant should be able to: 1. Understand autonomic deregulation in postural orthostatic tachycardia syndrome and syncope. 2. 3. The above information was provided by the
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Objectives & Notes
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Kaye H.
Kilburn, M.D. |
Date
of talk: |
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Bldg 7/7401 1000 So. |
Phone: 626/457-4202 |
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Fax: 626/457-4203 |
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Email: [email protected] |
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Training: |
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Current Job Description: |
Ralph
Edgington Professor of Internal Medicine, |
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University
of |
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Board Certifications: |
Diplomat American Board of Internal Medicine, American Board of Preventive Medicine Occupational Health |
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Other Information: |
Books: Chemical Brain Injury and Endangered Brains Mold and Mycotoxins, (Kilburn, KH ed) Written several articles |
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SPEECH TITLE: “RR Interval; Postural Hypotension – Shy-Drager” At the end of this Presentation, the participant should be able to: 1. Put the heart and vessels in perspective for effects of inhaled chemicals. 2. Understand measurements and interpretation heart rate monitoring. 3. What is and is not possible to learn from sinus arrhythmia. The above information was provided by the
Speaker. |
RR INTERVAL
POSTURAL HYPOTENSION–SHY-DRAGER
IN ADULTS
EXPOSED TO CHLORINE-CRESYLATE, HYDROGEN SULFIDE,
MOLDS AND
OTHER CHEMICALS
SIGNS OF AUTONOMIC NERVOUS SYSTEM DYSFUNCTION?
Kaye H. Kilburn, M.D.
and
Bradford E. Hanscom
(626) 457-4202
(626) 457-4203 FAX
RR Interval – Postural Hypotension – Shy Drager
Autonomic Failure
Kaye H. Kilburn
Bradford E. Hanscom
Background and Objective: Vagal heart variability can be monitored by recording beat to beat or RR intervals during deep slow breathing that exaggerates sinus arrhythmia, the normal RR variation with breathing. We determined whether a one day exposure to a chemical mixture of chlorine and cresylate affected RR variation 3 years after the incident. Normally heart rate increases during the inspiratory phase of respiration and it decreases in the expiratory phase. Vagus nerve regulated sinus arrhythmia is reduced or abolished by aging, diabetes mellitus and solvent exposure. The RR study was extended to 4 groups of people exposed to hydrogen sulfide, exposed to mold and mycotoxins, exposed to a variety of chemicals and to community control people.
Methods: We studied 58 adult subjects who had inhaled chlorine-cresylate 3 years earlier matched to 22 adult subjects unexposed to chemicals. A standard electrocardiograph machine was interfaced to an IBM compatible computer to record and time ECG-R waves during deep breathing at a rate of 6. An algorithm was developed to process the wave form variation so as to time all RR intervals and to create a confidence band of (± 10% mean time). The percentage of beats outside the confidence band were compared between exposed and control. Small R-waves when the chest was inflated and premature contractions were difficult to recognize. After the chlorine study a dedicated (2 lead and ground) electrocardiogram recorded R-waves with this patient lying after a 3-minute rest then they were guided to breathe 6 times per minute. I marked R-waves visually on 1 minute replays to calculate RR intervals and their means and standard deviations.
Results: Chlorine exposed subjects had 32.6% of beats outside this band compared to 47.7% of unexposed subjects (p <0.014). The standard deviation of the RR intervals were 22.7 and 31.2 respectively (p<0.043). Thus sinus arrhythmia was reduced after chlorine. For other groups mean Sd RR was 93 (range 12 to 253) in unexposed people, 93.3 in sewer gas exposed, 63.6 in hog lagoon exposed, and 96 in the chemical and mold group. Frequency distribution plots were asymmetrical with the median left of the mean in all groups including matched controls. Regression showed an age coefficient of -.92 per year and a constant of 139.8. Only the hog lagoon exposed were different from community controls, but they were not different from their matched controls. No feature or range of RR was predicted by demographics or neurobehavioral test scores.
Conclusion: Chlorine exposure reduced the respiratory variation of the heart rate. This effect on vagal function paralleled adverse effects on balance, choice reaction time, vision: color discrimination and visual field performance. Being downwind of hog manure lagoons also reduced variability but otherwise hydrogen sulfide, mold and mycotoxins and neurotoxic chemicals did not affect heart rate control(sinus arrhythmia).
Second Approach: The failure to adjust to orthostatic stress is easily measured by contrasting standing with lying blood pressure.
In a series of patients there were several patterns of response for maintaining standing blood pressure. The most frequent response was an increase in heart rate, next was an increase in systolic blood pressure. Without either of these responses a postural shift to standing caused blood pressure to fall below the lying level although syncope or lightheadedness were not observed. The frequencies of these responses are compared in 3 groups of patients and in control subjects.
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Objectives & Notes
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Freddy Abi-Samra,
M.D. |
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of talk: |
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Ochsner Clinic |
Phone: 504/842-4036 |
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Fax: 504/842-5823 |
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Email: [email protected] |
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Training: |
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Current Job Description: |
Director Section of Electrophysiology, Department of Cardiology |
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Residency: |
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Board Certifications: |
American Board of Internal Medicine, American Board of Cardiology |
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SPEECH TITLE: “Tilt Testing and Syncope: A Clinical Roadmap of the Autonomic Nervous System” At the end of this Presentation, the participant should be able to: 1. Understand and describe the schematics of autonomic control of the cardiovascular system. 2. Understand the value of tilt testing in stressing/evaluating the integrity of the various components of the autonomic nervous system. 3. Understand the difference between neurocardiogenic syncope and syncope do to autonomic dysfunction. The above information was provided by the
Speaker. |
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Objectives & Notes
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Roy
Fox, M.D. |
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of talk: |
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Phone: 902/860-0551 |
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Fax: 902/860-2046 |
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Email: [email protected] |
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Current Job Description: |
Director,
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Current Faculty Appointments: |
Professor
of Medicine; |
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Royal
Free Hospital, |
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Board Certifications: |
FRCP
( |
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Other Information: |
Master of Environmental Studies (Dalhousie) 2001 – Thesis “Multiple Chemical Sensitivity and the Environment”: “Env. Sensitivities in Dialysis Unit” Indoor Air 1999. ‘Environment & MCS’ Indoor Air 2002: “Adaptation in Individuals with Heightened Sensitivity to Combined Environmental Factors” Archives of Complex Env. Studies 2003. |
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SPEECH TITLE: “Autonomic Dysfunction in Multiple Chemical Sensitivity” At the end of this Presentation, the participant should be able to: 1. The symptoms & signs of autonomic dysfunction in MCS. 2. Research results which demonstrate dysfunction. 3. Overlap with Fibromyalgia & chronic fatigue syndrome and MCS. The above information was provided by the
Speaker. |
AUTONOMIC DYSFUNCTION IN MULTIPLE CHEMICAL
SENSITIVITY (MCS)
Roy Fox 1, Barbara Adams 1,
Tara Sampalli 1, Michel Joffres 1, 2
1
2
Community Health and Epidemiology, Faculty of
Medicine,
Multiple chemical sensitivity (MCS) is a chronic condition
which overlaps with other chronic illnesses, namely chronic fatigue syndrome
and Fibromyalgia. In our patient population who fulfill the published consensus
criteria for MCS, almost half the patients also fulfill the criteria for
chronic fatigue syndrome (Canadian consensus criteria 2003) and Fibromyalgia (
In a pilot study of 7 women with MCS, age matched with 7 healthy women, it was found that the autonomic response to exercise (6 minute walk on treadmill at self-selected walk speed) was significantly different. For patients with MCS the heart rate change was lower at 6 minutes, and the mean percentage change in diastolic blood pressure was higher at 3 minutes in comparison to control subjects. At the same time as these changes were noted the perceived exertion was higher for the MCS patients.
In a pilot study of challenge booth testing of individuals with and without MCS, a clear difference existed in the adaptation to the baseline experimental protocols. In the patient group, 25% required up to 4 sessions to adapt while at least 50% required at least 2 sessions. All the controls except one required only a single session to adapt to the baseline protocols. Cold feet and hands, fatigue, and numbness in fingers and toes were reported in the study as some of the symptoms experienced by patients when exposed to glue and dryer sheet.
The main function of the ANS is to maintain homeostasis in the face of changing demands. It is proposed that repetitive environmental stress requires repetitive adaptation and ultimately through damage or exhaustion, impaired function results. ANS dysfunction and impaired homeostasis accounts for many of the symptoms of patients with MCS. Patients are complex and there are other factors. A model of how ANS dysfunction fits in the spectrum of symptoms is presented.
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Objectives & Notes
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Freddy Abi-Samra,
M.D. |
Date
of talk: |
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Ochsner Clinic |
Phone: 504/842-4036 |
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Fax: 504/842-5823 |
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Email: [email protected] |
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Training: |
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Current Job Description: |
Director Section of Electrophysiology, Department of Cardiology |
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Medical School/University Attended: |
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Internship: |
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Residency: |
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Board Certifications: |
American Board of Internal Medicine, American Board of Cardiology |
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SPEECH TITLE: “A Pathophysiologic Approach to the Treatment of Vasodepressor Syncope” At the end of this Presentation, the participant should be able to: 1. Understand the pathophysiology of vasodepressor syncope. 2. Have adequate appreciation of the value of correct therapeutic schemes of VDS. 3. Tailor treatment of VDS based on provoked pathophysiologic disturbances of the autonomic cardiovascular regulation. The above information was provided by the
Speaker. |
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Objectives & Notes
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David
Hurst, M.D., Ph.D. |
Date
of talk: |
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23 Spring |
Phone: 207/883-6464 |
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Fax: |
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Email: [email protected] |
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Training: |
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Current Job Description: |
Private Practice – Otolaryngic Allergy |
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Current Faculty Appointments: |
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Internship: |
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Residency: |
Tufts
– B.U. – |
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Board Certifications: |
AAO-UNS, AAOA |
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Other Information: |
Ph.D.
– |
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SPEECH TITLE: “Chronic Otitis Media with Effusion – The Allergy Connection” At the end of this Presentation, the participant should be able to: 1. Understand how acute and chronic otitis media differ. 2. Understand how the middle ear behaves as a target organ of allergic inflammation. 3. Understand how allergies account for the risk factors and development of OME. The above information was provided by the
Speaker. |
Chronic Otitis Media with Effusion – The Allergy Connection
David Hurst, M.D., Ph.D.
Abstract:
Methods to control chronic OME, otorhea, and draining mastoid cavities will continue to fail as long as the effects of allergy on middle ear mucosa are ignored. We have demonstrated that all cells essential to a Th-2 driven immune response are active in the mucosa in a majority of ears from atopics with chronic OME. We will review studies which prove that the middle ear serves as target organs of allergy, present studies which prove allergy management to be > 83% efficacious, and demonstrate why chronic otitis media with effusion is an allergic disease.
References:
(PMID = Pub Med ID)
Otitis Articles
Middleton’s ALLERGY, Principles &
Practice; 2003 Mosby, ^th Ed. *****
Chapter
79 Skoner, Gentile, Mandel and
Casselbrant Otitis Media pg 1437-51 (209
ref)
PATTERSON’S ALLERGIC DISEASES, 6th Ed. 2002 Lippincott Williams & Wilkins ****
Chapter 11 Allergic Diseases of the Eye and Ear
P. Lieberman, M. Blaiss pg 209-23 (191
ref)
Smirnova
MG, Birchall JP, Pearson JP. *****
The immunoregulatory and allergy-associated cytokines
in the aetiology of the otitis media with effusion.
Mediators Inflamm. 2004 Apr;13(2):75-88.
PMID:
15203548
Rosenfeld RM, Kay D.
Natural history of untreated otitis
media.
Laryngoscope. 2003 Oct;113(10):1645-57.
Review. PMID:
14520089
Rosenfeld RM, Culpepper
L,, Grundfast KM, et. al.:
Clinical practice guideline: Otitis media with
effusion. Otolaryngol Head Neck Surg.
2004 May;130(5 Suppl):S95-118.
PMID: 15138413
Hurst DS, Venge P.
Evidence of eosinophil, neutrophil, and mast-cell
mediators in the effusion of OME patients with and without atopy.
Allergy.
2000 May;55(5):435-41.
PMID:
10843423
The impact of atopy on neutrophil activity in middle
ear effusion from children and adults with chronic otitis media.
Arch
Otolaryngol Head Neck Surg. 2002 May;128(5):561-6. Review.
PMID: 12003588
General Allergy
Safety
of home-based and office allergy immunotherapy: A multicenter prospective
study.
Otolaryngol
Head Neck Surg. 1999 Nov;121(5):553-61. PMID: 10547469
Passalacqua G, Canonica
GW. *****
Long-lasting clinical efficacy of
allergen specific immunotherapy.
Allergy. 2002
Apr;57(4):275-6.
PMID: 11906355
Passalacqua G, Canonica
GW. ***
Treating the allergic patient: think globally, treat
globally.
Allergy. 2002 Oct;57(10):876-83. “Unified Airway Disease”
PMID: 12269932
Smith GC, Pell JP. (A
great spoof on evidenced based medicine) *****
Parachute use to prevent death and major trauma
related to gravitational challenge: Systematic
review of randomised controlled trials.
BMJ. 2003 Dec 20;327(7429):1459-61.
Review.
PMID: 14684649
General Sinusitis/Asthma Nomenclature
Johansson SG, Bieber T, Dahl R, et. al.:Revised nomenclature for allergy for global use:
Report of the Nomenclature Review Committee of the World Allergy Organization,
October 2003.
J Allergy Clin Immunol. 2004 May;113(5):832-6.
PMID: 15131563
Johansson SG, Hourihane JO, Bousquet J,
Bruijnzeel-Koomen C, Dreborg S, et. al.: EAACI (the
A revised nomenclature for allergy. An EAACI position statement from
the EAACI nomenclature task force.
Allergy. 2001 Sep;56(9):813-24. Review. Erratum in: Allergy 2001 Dec;56(12):1229.
PMID: 11551246
more info and handouts:
David Hurst,
MD, PhD 207-883-6464
http://www.earallergy.com – go to Course Materials and Handout section
at bottom of selection panel.
Objectives & Notes
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Wallace
Rubin, M.D. |
Date
of talk: |
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Phone: 504/888-8800 |
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Fax: 504/455-6796 |
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Email: [email protected] |
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Training: |
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Current Job Description: |
Solo Practioner |
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Current Faculty Appointments: |
L.S.U. – Prof. |
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Internship: |
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Residency: |
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Board Certifications: |
Otolaryngology |
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Other Information: |
Dizziness – Etiologic Approach to Management |
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CASE STUDY: “Autonomic Nervous System Envrionmental Pollutants and the Inner Ear” At the end of this Presentation, the participant should be able to: 1. Evaluate inner ear function 2. Determine mechanisms causing abnormality 3. Treatment options The above information was provided by the
Speaker. |
ENVIRONMENTAL TRIGGERS LEAD TO ABNORMAL RESPONSES FOR THE RESPIRATORY SYSTEM
(EAR, NOSE, THROAT, LARYNX, AND LUNGS
Symptoms of chemical sensitivity typically are multiple in nature. Usually, one main organ is affected with secondary symptoms occurring in others. End-organ responses are often in the smooth muscles of the cardiovascular, gastrointestinal, urogenital, respiratory systems, or in the nervous system. Also, common early responses may occur in the skin (such as nonjaundice yellowing or edema) or other body organs.
At their onset, symptoms of chemical sensitivity are almost always reversible. As end-organ involvement increases, however, responses are more difficult to decipher and reverse.
Pollutant damage can occur at the main site of pollutant entry or in the detoxifying organ or it can be random, affecting any end-organ. Usually, however, the weakest end-organ, that which has been genetically damaged or previously harmed by trauma or exposure, is the first affected.
The sicker the patient with chemical sensitivity, the more diverse and multiple are his responses to a large number of individual incitants, suggesting primary and secondary organ involvement. For example, a patient develops rhinitis on exposure to formaldehyde. Later in the course of his illness, symptoms and signs of cystitis and colitis develop in addition to the rhinitis.
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