PubMed Health⌕ Search

Biomedical subjects

J Levi

Publications and source records attributed to J Levi.

At least 55 records · Page 3Linked to original sources
PubMed1993

Randomized comparison of the effects of tamoxifen, megestrol acetate, or tamoxifen plus megestrol acetate on treatment response and survival in patients with metastatic breast cancer.

BACKGROUND: The antioestrogen tamoxifen and progestins act via different receptors and may therefore have complementary effects against human breast cancer. This possibility was tested in a randomized study which compared the effects of tamoxifen, standard-dose megestrol acetate, and these two agents in combination, in patients with metastatic breast cancer. PATIENTS AND METHODS: 184 post-menopausal patients with metastatic breast cancer were randomized to initial treatment with either tamoxifen (TAM) 40 mg daily, megestrol acetate (MA) 160 mgm daily, or the combination of the two administered simultaneously. Patients crossed over to the alternative single agent on relapse or disease progression. Patients were evaluated for response, time to initial and ultimate treatment failure, and survival. RESULTS: There were no significant differences between the three groups with respect to response rates, nor the other parameters. Patient survival was significantly associated with age > 60 years, ER positive status, and the absence of visceral metastases. CONCLUSIONS: TAM and MA are both equally effective in response induction as initial treatments and the combination has no advantage. Sequential treatment is still optimal, TAM being the preferred initial agent in view of the reported side effects with MA.

Aged↗
PubMed1993

Angiotensin-converting enzyme inhibition and anaemia in renal patients.

A 35-year-old renal transplant patient with stable renal function developed an unexplained anaemia. Appropriate investigations proved non-diagnostic. Only when enalapril therapy was stopped did the anaemia reverse and haemoglobin levels returned to pre-treatment levels. An association between angiotensin-converting enzyme inhibitors and anaemia in patients with renal failure is becoming more evident. A literature review of this problem and its possible pathogenesis in patients with renal failure is given.

Adult↗
PubMed1993

Serum insulin-like growth factor-binding protein-2 (IGFBP-2) is increased and IGFBP-3 is decreased in patients with prostate cancer: correlation with serum prostate-specific antigen.

Insulin-like growth factors (IGFs) are potent mitogens that stimulate the growth of prostate cells. In serum, IGFs circulate bound to IGF-binding proteins (IGFBPs), which modulate their proliferative action. We studied the electrophoretic pattern of IGFBPs in the serum of patients with prostate cancer and in individuals with increased serum levels of prostate-specific antigen (PSA) in the absence of prostate malignancy. Serum IGFBP-2 was dramatically increased in patients with metastatic prostate cancer compared with healthy controls (23.83 +/- 6.93% vs. 2.95 +/- 0.52% of total serum IGFBPs; P < 0.02). A moderate rise in IGFBP-2 was also observed among patients with increased PSA without malignancy. In contrast, a decrease in serum IGFBP-3 was detected in most patients with metastatic prostate cancer (68.2 +/- 9.1% vs. 95.4 +/- 0.9% of total serum IGFBPs; P < 0.02) and was more pronounced in advanced cases. A highly significant correlation between serum IGFBP-2 and PSA levels was found (r = 0.62; P < 0.002), with a significant negative correlation between serum PSA and IGFBP-3 (r = -0.63; P < 0.002). We suggest that IGFBPs may be involved in growth modulation of prostate malignancy and that alterations in their serum levels may serve as a marker for prostate cancer.

Aged↗
PubMed1993

Tubulointerstitial nephritis and uveitis: association with suppressed cellular immunity.

It is suggested that tubulointerstitial nephritis and uveitis (TINU) is a cell-mediated immune disease with a favourable response to treatment with steroids. However, long-term follow-up has not been described and data on immunological studies are limited. The aim of this study was to evaluate the clinical features in patients with TINU who have had a long follow-up period, and in parallel to assess their cellular immunity and HLA typing. Four women with TINU were followed for 5.7 +/- 3.6 years. On remission they were studied for T-cell-mediated immunity by skin tests, T-cell subpopulations, and lymphokine secretion in vitro. The lymphokines included interleukin-2, gamma-interferon, tumour necrosis factor, and colony-stimulating factor. The in vitro response to AS101, a previously described immunomodulator, was evaluated. HLA-typing was also performed. The nephritis, which occurred once, was resolved in all patients and did not recur. In contrast, numerous relapses of uveitis occurred despite topical or systemic steroid treatment. The patients' T-cell subpopulations did not differ from controls, but they revealed anergy to skin tests and a very low secretion rate of lymphokines. AS101 corrected the suppressed secretion in vitro. A high frequency of HLA-DR6 antigen was found in the TINU patients. TINU is probably a systemic disease with a chronic relapsing course of the uveitis but with complete clinical recovery of the nephritis. Both in vivo and in vitro T-cell functions are suppressed during remission.

Adolescent↗
PubMed1993

Red blood cell calcium level is elevated in women: enhanced calcium influx by estrogens.

Red blood cell (RBC) calcium level had been found to be higher in women than in men. This study was designed to evaluate whether this is a general phenomenon and to elucidate a possible mechanism for a gender-related difference in RBC calcium levels. Differences in RBC calcium levels between women and men were examined in normal subjects, in patients with chronic renal failure (CRF) who were known to have elevated RBC calcium levels, and in female and male rats. RBC calcium level was higher in healthy women (6.1 +/- 0.5 mumol/L in women vs 4.4 +/- 0.3 mumol/L in men; p < 0.01), in women with CRF (45.8 +/- 11.8 mumol/L vs 15.4 +/- 1.1 mumol/L in men with CRF; p < 0.025) and women undergoing hemodialysis treatment (43.4 +/- 4.7 mumol/L vs 8.8 +/- 0.9 mumol/L in men undergoing hemodialysis p < 0.001). RBC calcium levels in female rats were also significantly higher than those in male rats. Ovariectomy reduced RBC calcium levels in female rats to those of male rats, whereas castration of male rats had no effect on RBC calcium levels. These in vivo findings suggest that the elevated RBC calcium level is associated with activity of female sex hormones. To investigate a possible mechanism, the in vitro effect of beta-estradiol on calcium 45 influx into RBCs and its effect on basal and calmodulin-stimulated Ca adenosine triphosphatase (CaATPase) activity in RBC membranes was determined. CaATPase activity was not affected by beta-estradiol at various concentrations and different incubation periods.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Ifosfamide combination regimens for soft-tissue sarcoma.

Two trials using ifosfamide-based combination chemotherapy for advanced soft-tissue sarcoma have been completed. In the first study, 50 evaluable patients received ifosfamide (5 g/m2) with mesna (5 g/m2) and doxorubicin (40 or 60 mg/m2) intravenously (i.v.) every 3 weeks. In all, 11 patients (22%) achieved an objective response [3 complete responses (CRs) and 8 partial responses (PRs)]. Toxicities included leukopenia, febrile neutropenia, nausea and vomiting, and alopecia. The overall median survival was 12 months. In the second study, 51 evaluable patients received ifosfamide (3 g/m2) with mesna (3 g/m2), both being given i.v. on day 1, together with etoposide (100 mg/m2) infused i.v. daily for 3 days. Six patients (12%) achieved objective responses (1 CR, 5 PRs). Toxicities included leukopenia, nausea and vomiting, and alopecia. The overall median survival was 7.4 months. Neither of these combination regimens appears to be more effective in advanced soft-tissue sarcoma than single-agent therapy with either ifosfamide or doxorubicin. If the results of chemotherapy in the management of these tumors are to be improved a new approach to therapy is clearly required.

Adolescent↗
PubMed1993

Cytokine production by mononuclear cells from patients with chronic renal failure.

The interleukins play a central role in the regulation of the immune system function. In the present study we compared the ability of peripheral blood mononuclear cells (PBMC) from three groups of uremic patients and 15 healthy controls to release interleukin-2 (IL-2) and interleukin-3-like activity (IL-3-LA). In the first group, 11 patients with chronic renal failure (CRF) not yet on dialysis treatment, IL-2 and IL-3-LA were similar to those of the controls. The finding of an increased IL-2 activity in the CRF group suggests that factors other than membrane blood interactions are involved in its production. In the second group, 15 patients on hemodialysis (HD), Il-2 activity measured pre-HD was higher than in the control group (P < 0.005) but decreased slightly post-HD; and IL-3-LA pre-HD was higher than in the controls but decreased post-HD. The pre-HD high levels of IL-2 and IL-3-LA support the role of membrane blood interactions in inducing cytokine activity. In the third group, 13 patients on continuous ambulatory peritoneal dialysis (CAPD), IL-2 and IL-3-LA were similar to the controls. The normal values found in the CAPD group suggest that this modality of dialysis leads to a more normal cytokine production and thus may prevent complications observed in acute and chronic hemodialysis.

Adult↗
PubMed1992

AIDS and activists.

Explore the source record for details and available documents.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Resuscitation. Patient and staff attitudes in the context of cancer.

One hundred oncology and hematology cancer patients from a major teaching hospital and their treating doctors were studied regarding their attitudes toward cardiopulmonary resuscitation (CPR). A descriptive approach was used, incorporating semistructured interviews of patients and medical staff and established questionnaire measures, examining knowledge of and attitudes toward disease and treatment, and projected attitude toward CPR and current psychological functioning. One-third of the patient sample anticipated a time when they would not consent to cardiopulmonary resuscitation. This was significantly associated with good disease prognosis. Patients with a psychiatric past history were also overrespresented. It appears that patient attitude to treatment withdrawal and refusal of CPR is related to disease progression and likely to change over time. This supports a dynamic and evolving model of advance directives rather than any fixed decree. Medical staff reported that they planned to provide half the sample with intensive medical treatment (including Intensive Care support in the event of their cardiac arrest), and 32% were designated for ward-based resuscitation only. Eighteen percent would not be resuscitated. These patients were older, had more treatment side effects, and a poorer quality of life. Those patients with either a psychiatric past history or higher ratings of depressive affect were also overincluded in the doctors' "Do-Not-Resuscitate" (DNR) group. These results suggest that there are other qualitative factors (e.g., current psychological functioning and past psychiatric history) that contribute to DNR decisions beyond the usual disease-based criteria seen in formal DNR protocols.

Adult↗
PubMed1992

Assessment of combined 24,25(OH)2D3 and 1 alpha (OH)D3 therapy for bone disease in dialysis patients.

An increasing body of experimental data suggests a role for 24,25(OH)2D3 in bone metabolism. The present study was carried out to assess a possible therapeutic role of this vitamin D metabolite in renal osteodystrophy. Twenty-two chronic dialysis patients, most of whom were previously maintained on 1 alpha (OH)D3 therapy, received additional treatment with 10 micrograms/day 24,25(OH)2D3 and were compared to 19 patients receiving 1 alpha (OH)D3 alone. Analysis of transiliac bone biopsies obtained at study entry and following 10-16 months of treatment revealed that the combined therapy produced a decrease in bone turnover. Specifically, the addition of 24,25(OH)2D3 inhibited an increase in trabecular bone volume (BV/TV) and suppressed osteoclastic parameters. Thus BV/TV increased from 26.2 +/- 8.6 to 32.1 +/- 7.5% (p < 0.01) in the 1 alpha (OH)D3 group, but it remained unchanged in the combined therapy group. In contrast, the eroded surface (ES/BS), the osteoclast surface (Oc.S/BS), and the osteoclast numbers were significantly suppressed in patients receiving both 24,25(OH)2D3 and 1 alpha (OH)D3, as compared with those receiving 1 alpha (OH)D3 alone (p < 0.01, p < 0.01, and p < 0.001, respectively). These improvements were independent of changes in 1 alpha (OH)D3 dosage. The extent of bone aluminium deposits was unrelated to the administration of 24,25(OH)2D3 or to its effect. 24,25(OH)2D3 therapy was not associated with any adverse effects.

24,25-Dihydroxyvitamin D 3↗
PubMed1992

The effect of high-dose nifedipine on renal hemodynamics of cyclosporine-treated renal allograft recipients.

Cyclosporine has been shown to reduce renal perfusion and to decrease glomerular filtration rate. Experimental studies suggest that nifedipine might reverse this renal vasoconstrictive effect of cyclosporine. We studied renal hemodynamics of 5 cyclosporine-treated renal transplant recipients before and after 2 weeks of therapy with high-dose nifedipine (up to 120 mg/day). Pretreatment GFR and renal plasma flow (RPF) were decreased. Following administration of nifedipine, RPF increased by 18% (P less than 0.01), while GFR did not change. Filtration fraction decreased by 10.5% (P less than 0.01). Mean arterial pressure declined from 111 +/- 5 to 96 +/- 3 mmHg (P less than 0.01). Renal vascular resistance dropped by 25% (P less than 0.01). Calculated postglomerular plasma flow increased by 20.5% (P less than 0.01). Urinary albumin excretion rate was unaffected. Cyclosporine whole blood levels were unchanged. The increase in RPF and in postglomerular plasma flow suggests that high-dose nifedipine might lessen cyclosporine-induced glomerular and interstitial ischemia in renal allograft recipients.

Adult↗
PubMed1991

X-ray microanalysis of the fingernails of uremic patients treated by hemodialysis.

The element content of the fingernails of 16 patients with chronic renal failure (CRF) treated by hemodialysis was examined by dispersive microanalysis. In comparison with matched controls, the results showed a statistically significant decrease in the percentage of Cu, Fe and Zn and an increase in S. The Al content did not differ significantly from that of the controls. There was no correlation between the serum values of Al, Fe and Zn and their content in the fingernails of the patients. On the other hand, Cu was found to be low both in the sera and in the fingernails of the CRF patients.

Adult↗
PubMed1991

Impaired DNA repair in patients with end-stage renal disease and its improvement with hemodialysis.

DNA repair following ultraviolet (UV)-induced DNA damage is decreased in some cancer-prone diseases. Cancer frequency in end-stage renal disease patients is higher than in the normal population. Therefore, DNA repair from UV-induced damage in lymphocytes was determined in 11 hemodialysis (HD) patients, 11 patients on continuous ambulatory peritoneal dialysis (CAPD), 10 patients with chronic renal failure (CRF) who had not yet been dialyzed and in 12 controls. UV irradiation at 254 nm was followed by 3H-thymidine incorporation in the presence of hydroxyurea. DNA repair synthesis in CAPD and CRF was significantly reduced to only 69 and 54% of the control, respectively, whereas the repair of HD patients was close to normal (86%, p = n.s.). The impaired ability to correct DNA damage may contribute to the increased cancer incidence in uremic patients.

Adult↗