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Biomedical subjects

J Levi

Publications and source records attributed to J Levi.

At least 91 records · Page 5Linked to original sources
PubMed1989

Brainstem auditory evoked responses in chronic renal failure and the effect of hemodialysis.

Brainstem auditory evoked responses (BAER) were recorded in patients with chronic renal failure before commencement of chronic dialysis treatment, and in patients with end-stage renal failure on chronic hemodialysis for several years. Both groups of patients had delayed latencies of the third and fifth waves. The patients on hemodialysis revealed delayed latency of interpeak I-V as well. There was no correlation between wave latency, serum urea, creatinine, PTH or duration of chronic hemodialysis treatment. A hemodialysis session led to a slight shortening of the third wave. This study suggests that neural conduction along the brainstem in patients with chronic renal failure is delayed even before hemodialysis is started. Although 1 dialysis session may have some beneficial effect, long-term hemodialysis treatment does not seem to shorten the delay in neural conduction observed in patients with chronic renal failure.

Adolescent↗
PubMed1989

Effect of prostaglandin on indomethacin-induced increased intestinal permeability in man.

This study examines whether NSAID induced disruption of small intestinal integrity is preventable by concomitant prostaglandin administration, and whether prostaglandins themselves interfere with intestinal permeability and absorption. Twelve subjects underwent testing following treatment as indicated: baseline, no treatment rioprostil, 300 micrograms, at -9 and -1 h indomethacin, 75 mg and 50 mg, at -9 and -1 h respectively rioprostil plus indomethacin, regimen as above. At 0800 h (0 h) subjects drink a solution containing 51CrEDTA 100 microCi, L-rhamnose 0.5 g, D-xylose 0.5 g and 3-O-methyl-glucose 0.2 g; this is followed by a 5-h urine collection. The amount of test substance in the urine reflects non-mediated intercellular and transcellular permeability, and passive and active carrier mediated transport systems, respectively. Permeation of L-rhamnose, D-xylose and 3-O-methyl-glucose is unaffected by rioprostil and/or indomethacin. Indomethacin significantly increases intestinal permeability to 51CrEDTA; coadministration of rioprostil, however, significantly decreases this detrimental effect of indomethacin. These findings suggest that prostaglandins are essential for maintaining small intestinal integrity in man and lend further support to the suggestion that NSAIDs damage the small intestine by reducing mucosal prostaglandin synthesis.

3-O-Methylglucose↗
PubMed1989

Red blood cell calcium homeostasis in patients with end-stage renal disease.

Low cell calcium level is essential for preservation of red blood cell (RBC) membrane deformability and survival. RBCs from patients with end-stage renal disease (ESRD) demonstrate reduction in membrane deformability, possibly as a result of increased RBC cellular calcium level. To evaluate calcium homeostasis in RBCs from patients with ESRD, we measured cell calcium level, basal and "calmodulin"-stimulated calcium-stimulated Mg-dependent ATPase (CaATPase) activity, and calcium 45 efflux were measured before and after hemodialysis. The in vitro effect of uremic plasma and of urea on CaATPase activity of normal RBCs was tested, and 45Ca influx into RBCs of patients undergoing hemodialysis also was determined. A morphologic evaluation of red cells from patients with ESRD was performed with a scanning electron microscope. RBC calcium level in patients (mean +/- SEM 21.2 +/- 2.8 mumol/L of cells; n = 28) was higher than in controls (4.9 +/- 0.3 mumol/L of cells; n = 24; p less than 0.001). Hemodialysis had no effect on cell calcium level. Both basal and "calmodulin"-stimulated RBC CaATPase activities in patients with ESRD (n = 9) were reduced by approximately 50% (p less than 0.01), but after hemodialysis, enzyme activity returned to normal. 45Ca efflux from calcium-loaded cells, which was 2574.0 +/- 217.0 mumol/L of cells per 0.5 hours before hemodialysis, increased to 3140.7 +/- 206.8 mumol/L of cells per 0.5 hours after hemodialysis (p less than 0.005). In vitro incubation of normal RBCs with uremic plasma depressed CaATPase activity, but incubation with urea had no effect. RBCs of patients with ESRD revealed increased 45Ca influx, 7.63 +/- 1.15 mumol/L of cells per hour versus 4.61 +/- 0.39 mumol/L of cells per hour (p less than 0.025). RBCs of patients revealed a high incidence of spherocytosis and echynocytosis, which correlated with a high cell calcium level (r = 0.894, p less than 0.01). These results indicate that RBC calcium level is elevated in patients with ESRD and suggest that a dialyzable uremic factor inhibits RBC CaATPase activity and thereby calcium efflux, which may account for the elevated cell calcium level. The increased calcium influx further increases cellular calcium level. These abnormalities are associated with spherocytosis and echynocytosis and may contribute to the shortened survival of RBCs in uremia.

Adult↗
PubMed1989

Empiric single agent or combination antibiotic therapy for febrile episodes in neutropenic patients: an overview.

Febrile episodes during chemotherapy-induced neutropenia are a frequent cause of morbidity and mortality in cancer patients. Empiric antibiotic therapy commencing at the onset of fever is selected according to three principles: intravenous therapy is used to rapidly achieve bactericidal serum levels, antibiotics with appropriate antibacterial spectra are required, and combinations of antibiotics have been preferred for their synergistic activity. Initial empiric monotherapy with single antibiotics such as imipenem which have a sufficiently broad antibacterial spectrum in their own right are potentially as efficacious as conventional combination therapies. Granulocytopenic periods complicated by fever are significantly longer in patients receiving chemotherapy for leukaemia than in patients undergoing treatment for lymphoma and solid tumours. However, defervescence of fever following commencement of antibiotic therapy occurs equally rapidly in these three groups. The persistent granulocytopenia leaves leukaemic patients at greatest risk of breakthrough or second infections. These patients therefore appear to be the most likely to benefit from the clinical use of haemopoietic growth factors such as granulocyte and granulocyte-macrophage colony-stimulating factor.

Agranulocytosis↗
PubMed1989

Thrombocytopenia associated with hypersensitivity to ranitidine: possible cross-reactivity with cimetidine.

A rare case of thrombocytopenia associated with ranitidine is described. The thrombocytopenia was accompanied by eosinophilia and slightly elevated serum IgE. The platelet and eosinophilic counts returned to normal as soon as the drug was stopped. Cell-mediated immunity (CMI) determined in vitro by the leukocyte migration inhibition factor test was found against ranitidine and cimetidine. IgE antibody response against both drugs was also found by the mast cell degranulation test. These data suggest an association between the ranitidine-induced thrombocytopenia and both humoral antibody response and CMI. Cross-reactivity between the two H2-receptor antagonists is suggested, as well.

Cell Migration Inhibition↗
PubMed1989

Effect of verapamil on bone resorption and formation in uremic rats.

It has been shown in vitro that verapamil inhibits parathyroid hormone-induced bone resorption. To determine the effect of verapamil administration on bone histology in rats with chronic renal failure, male Wistar rats were divided into three groups: subtotally nephrectomized (SNX), SNX treated with verapamil, 8 mg/kg/day p.o. (SNX-V) and control (C). Thirteen weeks later, the mandibular condyle bone was studied by histomorphometry. When compared to C rats, SNX rats had active bone disease, with increased resorption parameters (resorption surface, active resorption surface, osteoclast number) and accelerated mineral appositional rate. These parameters improved with verapamil administration. When compared to C rats, SNX-V rats had decreased osteoid seam width and mineral appositional rate. Serum parathyroid hormone was similarly elevated in both uremic groups. These data suggest that verapamil administration improves active bone disease in rats with chronic renal failure and decreases bone formation.

Animals↗
PubMed1989

Hypouricemia due to familial isolated renal tubular uricosuria. Evaluation with the combined pyrazinamide-probenecid test.

A Jewish Iraqi woman with familial isolated renal tubular uricosuria, urate clearance of 60.5 +/- 5.7 ml/min and hypouricemia of 1.0 +/- 0.2 mg/dl is described. The combined pyrazinamide-probenecid test suggested a presecretory defect in urate reabsorption. Four offspring were moderately affected. This family represents the sixth Jewish Iraqi family with familial isolated presecretory uricosuria, and emphasizes the marked prevalence of this disease among the Iraqi Jewish population. Since the inheritance of the presecretory defect is autosomal recessive, we suggest that this family is an example of pseudodominant transmission. The combined pyrazinamide-probenecid test may cause a reduction in glomerular filtration rate and filtered load of urate and thereby affect urinary excretion rate of urate in patients with urate wasting.

Creatinine↗
PubMed1988

A phase II trial of oral 4'demethoxydaunorubicin (DMDR) in inoperable non small cell lung cancer.

4'Demethoxydaunorubicin, an orally active daunorubicin analogue, was administered to 22 patients with inoperable non small cell lung cancer (NSCLC). Patients were stratified into good and poor risk categories and received doses of 45 mg/m2 and 40 mg/m2 respectively at 28 day intervals. All 22 patients were evaluable for response: No tumour responses occurred. Therapy was well tolerated. Mild gastrointestinal toxicity occurred in 41% of patients. Leucopenia with a wcc less than 3 x 10(9)/L occurred in 33% of patients and thrombocytopenia less than 100 x 10(9)/L in 9%. Severe marrow toxicity was rare and there appeared to be no difference in terms of toxicity between the different dose levels. DMDR appears to have no useful clinical activity in NSCLC.

Administration, Oral↗
PubMed1988

Sialic acid and neuraminidase activity in rat kidneys 6 months after uninephrectomy.

Sialic acid and neuraminidase activity were determined in the cortex of the remnant kidneys of six uninephrectomized rats. As controls served either the kidneys removed at operation or age-matched kidneys from eight sham operated rats. Six months after uninephrectomy the kidneys became hypertrophied and their mean weight was about 40% higher than age-matched kidneys. Blood urea and creatinine and protein levels in 24-hr urine collections were significantly higher in the experimental animals as compared to those of the same animals before nephrectomy and to sham operated rats, indicating a marked impairment of kidney function. The mean concentration of sialic acid in the cortex of hypertrophied kidneys was not statistically different from either that of the removed or that of the age-matched kidneys. Neuraminidase activity expressed as either per gram fresh tissue or per milligram protein, was not different in the removed and in the hypertrophied kidney. The activity, however, in the latter was significantly lower than in the age-matched kidneys. Whether this finding can be associated with the impairment of kidney function in rats 6 months after uninephrectomy remains to be studied.

Animals↗
PubMed1988

A phase II trial of oral 4'demethoxydaunorubicin in advanced colorectal carcinoma.

4'Demethoxydaunorubicin (DMDR), an orally active daunorubicin analogue, was administered to 22 patients with advanced colorectal carcinoma. Patients were stratified into good- and poor-risk categories and received doses of 45 mg/m2 and 40 mg/m2, respectively, at 28-day intervals. Twenty-one patients were evaluable for response. No tumour responses occurred, although six patients had stable disease. Therapy was well tolerated. Mild gastrointestinal toxicity occurred in 45% of patients. Marrow toxicity was common and usually mild. DMDR appears to have no useful activity in colorectal carcinoma.

Administration, Oral↗
PubMed1988

Surveillance for stage I non-seminomatous germ cell tumours of the testis: the optimal protocol has not yet been defined.

Forty-six patients with clinical stage I testicular non-seminomatous germ cell tumours were followed up according to a protocol of active surveillance between 1979 and 1987. The median follow-up time was 40+ months. Thirteen patients (28%) relapsed, predominantly in retroperitoneum and/or lung. Ten of these relapses (76%) occurred within 8 months of orchiectomy. Relapses occurred in 7/35 T1 tumours and 5/10 T2 to T4 tumours. No correlation was detected between the histological type and relapse rate. Three late relapses were diagnosed at 23, 29 and 36 months. Eleven of the relapsed patients remain in prolonged complete remission after PVB chemotherapy +/- surgery; one patient, who initially refused treatment at the time of relapse, has died. Another relapsed with predominant elements of rhabdomyosarcoma intermingled with malignant teratoma in a bone metastasis. He had a partial response to PVB chemotherapy but subsequently died. Thirty-four patients (74%) did not undergo lymphography (LG) and had a higher relapse rate (11/34) than those who had LG (2/12); this was not a statistically significant difference in this small series. The policy of active surveillance is not yet the "state of the art" and should be under constant scrutiny with respect to safety and practice.

Adult↗
PubMed1988

Establishing breast feeding in hospital.

The experience and practice of the author is described in her appointment as a breast feeding advisor to the paediatric and obstetric units at University College Hospital with special responsibility for supervising infant feeding, especially breast feeding in the maternity unit. During 1980-5 there were 13,185 mothers whose babies fed. The feeding method of 12,842 mothers was recorded on discharge from the postnatal wards and 77% were breast feeding; only 3% of these mothers gave complement feeds of infant formula. The practices in the maternity wards to enable mothers to establish successful breast feeding and the methods of dealing with common problems of breast feeding are described.

Breast Diseases↗
PubMed1988

Chemotherapy for non-small cell lung cancer: a randomized trial of cisplatin/vindesine v no chemotherapy.

Separate but almost identical randomized trials testing the role of chemotherapy in non-small cell lung cancer (NSCLC) were started in Southampton, United Kingdom (UK) and in several centers in Australia. Between 1983 and 1987, 201 patients were assigned to either a chemotherapy arm: cisplatin 120 mg/m2 every 4 weeks and vindesine 3 mg/m2 weekly, or a no chemotherapy arm. Of 188 evaluable patients, 157 were randomized in Australia and 31 in Southampton. Objective responses after two cycles of cisplatin/vindesine were seen in 26 patients (28%). Median survival was 23 weeks for the treatment arm and 16 weeks in the no treatment arm (P = NS). Analysis of those patients with limited disease showed a median survival of 43 weeks for the chemotherapy arm and 26 weeks for the non-treatment arm (this difference approaches statistical significance). Toxicity was severe in the treatment arm, and all patients experienced subjective toxicity; 17 (18%) had WHO (World Health Organization) grade 3-4 myelotoxicity, 73% had grade 3-4 nausea and vomiting. There is a modest trend towards improved overall survival in patients with limited disease treated with chemotherapy. Because chemotherapy is palliative, future studies should have an appropriate control arm and should measure quality of life.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1988

Myoglobinuric renal failure in a newborn after traumatic delivery.

Fetal and neonatal asphyxia is the main cause of transient or acute renal failure (ARF) in neonates. Rhabdomyolysis and subsequent myoglobinuria have been rarely reported in neonates. We describe a case of ARF in a newborn infant in whom asphyxia, birth trauma and hypovolemic shock precipitated rhabdomyolysis which contributed to ARF.

Acute Kidney Injury↗