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Biomedical subjects

C Levine

Publications and source records attributed to C Levine.

At least 19 recordsLinked to original sources
PubMed1995

Stomal seeding of head and neck cancer by percutaneous endoscopic gastrostomy tube placement.

BACKGROUND: Percutaneous endoscopic gastrostomy (PEG) tubes have replaced nasogastric tubes and Stamm gastrostomy tubes as a preferred means of feeding for patients with head and neck cancers, as recommended by the results of large series. A patient with stomal seeding of squamous cell carcinoma of the upper aerodigestive tract by PEG placement was reported. A review of literature was performed. METHODS: A Medline search of implantation of squamous cell carcinoma from the upper aerodigestive tract to PEG exit site since the introduction of PEG was performed. RESULTS: Two reports of implantation of squamous cell carcinoma of the upper aerodigestive tract to PEG exit site were found. Both patients and our patient were staged T4. CONCLUSIONS: Implantation of squamous cell carcinoma from the upper aerodigestive tract to the PEG exit site is a rare and late complication. Its prevalence is not known. For patients with a significant amount of squamous cell carcinoma in the upper aerodigestive tract, we recommend Stamm gastrostomy over PEG insertion by the pull technique. There is no report of such late complication by the push technique.

Abdominal Muscles↗
PubMed1995

Social interventions in the care of human immunodeficiency virus (HIV)-infected pregnant women.

The incidence of infection with the human immunodeficiency virus (HIV) is increasing among women of childbearing age. Women now account for 18% of the total number of cases of the acquired immunodeficiency syndrome (AIDS), compared with 9% a decade ago. The medical care of pregnant HIV-infected women must take into account the high prevalence of substance abuse, preceded and often accompanied by significant levels of physical, emotional, and sexual trauma, and the concomitant stigmatization of these women in their families and communities. Pregnancy is often a time when women are motivated to make major positive behavioral and life-style changes. To do this, they need ongoing, multidisciplinary counseling and support, with recognition that progress may be intermittent and slow. The Special Prenatal Care Program at Bellevue Hospital is described to show the level of resource commitment that is needed as well as the nearly universal acceptance of voluntary HIV counseling and testing in these conditions. Trends in permanency planning for the children of HIV-infected women are described. Future research needs are outlined, including female-specific drug treatment and more effective contraceptive technology for both men and women.

Adult↗
PubMed1995

Orphans of the HIV epidemic: unmet needs in six US cities.

In the United States, an estimated 72,000-125,000 children and adolescents will lose their mothers to AIDS by the year 2000. Six cities have been particularly hard hit: New York City, Newark, Miami, San Juan, Los Angeles, and Washington, DC. The most urgent unmet needs for children, their families and new guardians are for mental health services, including bereavement counselling; transitional services to help overcome the loss of AIDS-related benefits following the parent's death; legal services; housing supports, and appropriate evaluations and referrals by juvenile justice and school staff to community-based services. Professional staff need additional training and support. Public policies and legal standards should stress a preference for maintaining children in their extended families, broadly defined, whenever possible. Much more needs to be done to improve the lives and futures of these youth.

Acquired Immunodeficiency Syndrome↗
PubMed1995

A comparison of five methods of temperature measurement in febrile intensive care patients.

BACKGROUND: A clinically useful temperature measurement method should correlate well with the body's core temperature. Although previous investigators have studied temperature readings from different sites in hypothermic and normothermic patients, none have compared methods specifically in febrile patients. OBJECTIVE: To compare temperature measurement methods in febrile intensive care patients. METHODS: Temperature readings were obtained in rapid sequence from an electronic thermometer for oral and axillary temperature, rectal probe, infrared ear thermometer on "core" setting, and pulmonary artery catheter, approximately every hour during the day and every 4 hours at night. The sample consisted of 13 patients with pulmonary artery catheters and with temperatures of at least 37.8 degrees C. RESULTS: Rectal temperature correlated most closely with pulmonary artery temperature. Rectal temperature showed closest agreement with pulmonary artery temperature, followed by oral, ear-based, and axillary temperatures. Rectal and ear-based temperatures were most sensitive in detecting temperatures greater than 38.3 degrees C. Likelihood ratios for detecting hyperthermia were 5.32 for oral, 2.46 for rectal, and 1.97 for ear-based temperature. Rectal and ear-based temperatures had the lowest negative likelihood ratios, indicating the least chance of a false negative reading. Axillary temperature had a negative likelihood ratio of 0.86. CONCLUSIONS: Rectal temperature measurement correlates most closely with core temperature. If the rectal site is contraindicated, oral or ear-based temperatures are acceptable. Axillary temperature does not correlate well with pulmonary artery temperature. These results underscore the importance of consistency in method when establishing temperature trends, and of awareness of method when interpreting clinical data.

Adult↗
PubMed1994

Ethics, epidemiology, and women's health.

Ethical issues arise throughout the conduct of epidemiologic studies, in the processes of determining the study question, designing the protocol, and implementing the study. There also is an ethical dimension when studies are not done, for example, in studies of the effect of drugs and chemicals on male reproductive capacity. Harm as well as risk must be considered in the conduct of epidemiologic studies. The ethical principles that govern research, while independently justifiable, may come into conflict. Principles that govern research also may conflict with those that predominate in clinical practice. An example is the current controversy over unblinding anonymous, newborn human immunodeficiency virus seroprevalence studies to identify potentially infected infants. As women's health becomes more prominent on the research agenda, the resolution of these conflicts will become a complex challenge to epidemiologists, ethicists, clinicians, and the communities they serve.

AIDS Serodiagnosis↗
PubMed1993

Bone metabolism in children with asthma treated with inhaled beclomethasone dipropionate.

Previous studies have shown that inhaled corticosteroids can affect bone metabolism in adults. A study to assess the effect of inhaled beclomethasone, 300 to 800 micrograms/day for at least 6 months (mean 25 months), was therefore undertaken in children. In part 1 of the study, 18 children with asthma, aged 4 to 17 years (mean 10.1 years), were compared with an age- and sex-matched group of children with asthma not treated with corticosteroids. In part 2, eight more pairs were compared. Comparisons were also made with 61 healthy children. Bone mineral density measured by radiographic absorptiometry, and bone mineral content measured by single-photon absorptiometry and by dual-energy x-ray absorptiometry, showed no significant differences. Serum levels of calcium, magnesium, zinc, total alkaline phosphatase, bone specific alkaline phosphatase, parathyroid hormone, 25-hydroxyvitamin D, and 1,25-dihydroxyvitamin D also showed no differences. The activity of tartrate-resistant acid phosphatase, a marker of bone resorption, was significantly lower in the beclomethasone group than in both the asthma control and the normal control groups, but urine calcium excretion did not differ. Patients with asthma had lower serum osteocalcin and higher serum copper levels than control subjects without asthma, but treatment with beclomethasone did not affect these values. We conclude that inhaled beclomethasone (up to 800 micrograms/day) does not reduce bone mineralization or increase bone resorption. Effects on bone formation were difficult to assess because asthma per se caused a significant reduction in osteocalcin, a sensitive marker of bone formation.

Acid Phosphatase↗
PubMed1993

Bull's-eyes and halos: useful MR discriminators of osseous metastases.

To evaluate the presence of (a) a focus of high signal intensity in the center of an osseous lesion (bull's-eye) as a negative discriminator for metastasis and (b) a rim of high signal intensity around an osseous lesion (halo) as a positive discriminator, a retrospective study was performed in 47 patients with osseous lesions suspect for metastatic disease who underwent magnetic resonance (MR) imaging of the pelvis. The findings in 17 patients with proved osseous metastasis were compared with those in 30 patients not believed to have metastatic disease; T1- and T2-weighted MR images were evaluated. The bull's-eye sign was found to be a specific indicator of normal hematopoietic marrow (sensitivity, 95%; specificity, 99.5%). The halo sign and diffuse signal hyperintensity were a strong indicator of metastatic disease (sensitivity, 75%; specificity, 99.5%). These results suggest that use of the bull's-eye sign as a discriminator of benign disease and use of the halo sign as a discriminator of metastasis help characterize suspect areas of marrow lesions.

Adult↗
PubMed1992

Clinical observations of nebulized flunisolide in infants and young children with asthma and bronchopulmonary dysplasia.

Severe bronchopulmonary dysplasia (BPD) is frequently associated with asthma. The combination is often severe enough to necessitate corticosteroid therapy. There are no commercially available nebulizer solutions of corticosteroids for use in infants and young children. Seven infants and small children with very severe BPD and asthma aged 6-24 months, were treated with flunisolide, 187-250 micrograms q.i.d. in the form of nasal spray delivered by nebulizer. After treatment for 2.5-20 months, four patients showed clinical improvement, one initially improved but later deteriorated and died of cardiac failure, and two patients showed no improvement and died within 3 months. The number of days of hospitalization was significantly reduced from 8.4/month to 2.5/month (P less than 0.05). No side-effects were detected and it was felt that the three patients who died, did so as a consequence of very severe BPD and its cardiac consequences. The suspension remained stable for 80 min when mixed with normal saline, cromolyn sodium, albuterol, or acetylcysteine. It is concluded that nebulized flunisolide is a potentially useful treatment for infants and young children with asthma and BPD.

Administration, Intranasal↗
PubMed1992

Familial pheochromocytomas with unusual associations.

Pheochromocytoma occurs in a familial pattern in approximately 10% of patients. Although most familial pheochromocytomas are an expression of the genetic abnormality of neuroectodermal dysplasia or the genetic syndrome of multiple endocrine neoplasia, some familial pheochromocytomas occur without associated disease. Two patients with familial pheochromocytoma are described. One had an extraadrenal tumor, producing severe renal artery stenosis and in whose family pheochromocytomas were found in three successive generations. A second had multiple pheochromocytomas associated with von Hippel-Lindau disease and a family member with multiple endocrine neoplasia type 2. The combinations and permutations of these genetic entities form discrete syndromes, with other peculiar interrelationships, pathologically related to an aberration in the migration, growth, and differentiation of the neural crest cells, and emphasizing their common neuroectodermal origin. The unique features that characterize the familial pheochromocytomas and cause diagnostic and therapeutic challenges are reviewed.

Adrenal Gland Neoplasms↗
PubMed1992

Renal infarction associated with an extraadrenal pheochromocytoma.

A patient with an abdominal extraadrenal pheochromocytoma showed computed tomography findings of renal infarction. Selective angiography of the affected kidney showed no evidence of arterial occlusion or emboli. We postulate that the renal infarcts were caused by reversible severe vasospasm associated with high systemic blood levels of norepinephrine and angiotensin II.

Angiography↗
PubMed1990

Antigen-specific and antibody-mediated growth inhibition of suppressor T cell hybridomas. Roles of H-2 and the CD3-T cell receptor-alpha/beta complex.

Eight different Ts cell hybridomas (including inducer (Ts1) and effector (Ts3) suppressor cells) specific for the 4-hydroxy-3-nitrophenyl acetyl (NP) hapten were tested for their ability to respond to Ag or anti-CD3 antibody in a growth-inhibition assay. Results suggest that the expression of the TCR-CD3 complex on Ts hybridomas is required for the Ag or anti-CD3-mediated growth inhibition. One of the CD3+, Ts hybridomas (CKB-Ts3-9.H3) was tested in detail; this CD4- effector suppressor cell hybridoma showed specific inhibition of growth in the presence of NP or NIP-coupled protein conjugates but not in the presence of other irrelevant hapten-protein conjugates. In addition, growth of this hybridoma was specifically inhibited by anti-CD3 and anti-TCR-alpha/beta antibodies but not by control hamster antibodies. In order to study the role of MHC molecules in Ag-mediated growth inhibition, Ts cell hybridomas were incubated with Ag (NP-keyhole limpet hemocyanin) in the presence of spleen cells from various H-2 congenic strains. The results suggest that the Ts hybridomas that express donor Ts-derived TCR beta-chain recognize Ag in an MHC-restricted manner, whereas the two Ts3 hybridomas that utilize BW5147-derived TCR-beta recognize Ag in H-2 unrestricted way. Co-incubation of anti-CD3 and anti-TCR-alpha/beta antibodies with specific Ag enhanced the Ag-mediated growth inhibition, whereas anti-LFA-1 antibody completely blocked the Ag-mediated effect. The combined data suggest that, like Th hybridomas, expression of CD3-associated-TCR complex is essential for the Ag responsiveness of Ts cell hybridomas.

Animals↗
PubMed1990

Primary macronodular hepatic tuberculosis: US and CT appearances.

Tuberculosis of the liver is uncommon except in association with miliary dissemination. Although hepatic involvement by tuberculosis tends to be diffuse, the macronodular or pseudotumor forms are rare. In addition, reports of actual imaging of tuberculous liver involvement are rare. A 5-year-old boy with a febrile illness due to macronodular hepatic tuberculosis, demonstrated by abdominal computed tomography (CT), and diagnosed by liver biopsy is presented.

Child, Preschool↗
PubMed1990

The imaging of body asymmetry and hemihypertrophy.

Localized soft tissue and bone overgrowth may be the result of many different causes and will vary in severity, from involvement of a single digit to one half of the body. There are a variety of causes, including chronic lymphedema; lymphangiomatous malformations; neurofibromatosis; vascular malformations including the Klippel-Trenaunay-Weber syndrome; macrodystrophia lipomatosa; multiple enchondromatosis and Maffucci's syndrome. More recently, the Bannayan syndrome and the Proteus syndrome have been documented among the causes. Unexplained hemihypertrophy may also occur in association with intra-abdominal neoplasms. The various entities are reviewed and their radiological features described and illustrated.

Abnormalities, Multiple↗
PubMed1990

HIV and childbearing.1. Uncertain risks and bitter realities: the reproductive choices of HIV-infected women.

Although most babies born to women with HIV will not develop AIDS, many health professionals and segments of the public object when these women will not forgo pregnancy. Such a view fails to consider fully the cultural, political, and socioeconomic contexts in which seropositive women make reproductive choices. HIV infection is only one of many conditions of chronic disease that can be passed from a woman to her fetus, and should not be singled out as a target for coercive policies. Rather, government and society have an obligation to empower women to protect themselves against HIV infection in the first place, and to offer them options for self-esteem and achievement independent of reproduction.

Acquired Immunodeficiency Syndrome↗
PubMed1990

AIDS and changing concepts of family.

The family in contemporary America may be defined as a group of individuals who by birth, adoption, marriage, or declared commitment share deep personal connections and are mutually entitled to receive, and obligated to provide, support of various kinds. As more people live in nontraditional arrangements, the gap between their needs and interests and official designations of family widens; AIDS has accelerated this change, affecting legal definitions, medical decisions, and questions of housing and child custody. While existing families adjust to the exigencies of AIDS, changing laws and customs may also affect the formation of new families. The epidemic threatens the intimacy and acceptance that ideally bind family ties, while at the same time reinforcing their necessity.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Use of drug lists.

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Family Practice↗