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Biomedical subjects

J R Levinson

Publications and source records attributed to J R Levinson.

11 recordsLinked to original sources
PubMed1999

Cardiac outcome in patients with subarachnoid hemorrhage and electrocardiographic abnormalities.

OBJECTIVE: Approximately 25% of patients with subarachnoid hemorrhage (SAH) have electrocardiographic (ECG) abnormalities consistent with myocardial ischemia or myocardial infarction (MI), and their cardiac prognosis remains unclear. The objective of this study was to determine the cardiac and all-cause mortality rate of a series of patients with SAH with ECG changes consistent with ischemia or MI. METHODS: Using an existing database of patients with SAH and predetermined ECG criteria for ischemia or MI, a study group of patients with abnormal ECG results within 3 days of presentation and before aneurysm surgery was identified. Database patients without abnormal ECG results served as a control group. Cardiac mortality, defined as death resulting from arrhythmia, congestive heart failure, or cardiogenic shock, was assessed by chart review. RESULTS: Of 439 patients with SAH in the database, 58 met the criteria for the study group. Forty-one of these patients were treated neurosurgically. No deaths resulting from cardiac causes occurred, and 20 patients died as a result of noncardiac causes. In a multivariable analysis, age older than 65 years and Hunt and Hess grade of at least 3 were predictive of all-cause mortality. ECG abnormalities, however, were not a statistically significant predictor. CONCLUSION: In patients with SAH and ECG readings consistent with ischemia or MI, the risk of death resulting from cardiac causes is low, with or without aneurysm surgery. The ECG abnormalities are associated with more severe neurological injury but are not independently predictive of all-cause mortality.

Adult↗
PubMed1991

Functional tests for myocardial ischemia.

Functional tests for myocardial ischemia are numerous. Most depend upon a combination of either exercise or pharmacologic intervention with analysis of the electrocardiogram, of regional perfusion with radionuclide imaging, or of regional wall motion with radionuclide imaging or echocardiography. While each test has unique features, especially at the research level, they are generally quite similar in clinical practice, so the clinician is advised to concentrate on one or two in which local expertise is high.

Coronary Disease↗
PubMed1991

Liver diseases in the elderly.

The preceding discussions outline the various forms of cirrhosis that may be encountered in the elderly population. Cirrhosis is not uncommon in older patients. Although it has been stated that most cirrhosis in the elderly is due to alcohol, these assumptions are perhaps overestimations. In the authors' experience, many older patients are inappropriately labeled with alcoholic liver disease--presumed guilty until proven otherwise--and have subsequently been shown to have nonalcoholic liver disease. Careful investigation is required. Hepatotoxic drug exposure (e.g., to alpha methyldopa, nitrofurantoin, or isoniazid) should be ruled out, and hepatitis B and hepatitis C serology obtained. Primary biliary cirrhosis may occur in both sexes, and thus antimitochondrial antibody should be assayed. Severe heart disease may result in cardiac cirrhosis in the elderly, with ascites and hepatomegaly. Alpha 1-antitrypsin deficiency, primary sclerosing cholangitis, idiopathic hemochromatosis, and chronic autoimmune hepatitis may result in advanced cirrhosis in the elderly; appropriate serum studies should be obtained. If questions remain and if therapy may be changed, liver biopsy can be performed. A recent study suggested, however, that the risk of hemorrhage from liver biopsy in the elderly may be increased, especially if malignancy is present. The era of treatment for liver diseases has arrived. Colchicine, methotrexate, ursodeoxycholic acid, and others have shown promise in the treatment of PBC, primary sclerosing cholangitis, and alcoholic liver disease. Corticosteroids may be lifesaving in autoimmune liver disease. Phlebotomy remains the treatment of choice for hemochromatosis in any age group. Interferons and other antiviral agents are being used in chronic type B and type C hepatitis. Treatment of the complications of cirrhosis in the elderly may be safely accomplished. Advanced age is not a contraindication to variceal sclerotherapy. Vasopressin, however, may be contraindicated in the elderly patient if there is an underlying history of atherosclerotic coronary or peripheral vascular disease. Large-volume paracentesis and peritoneal venous shunting can afford symptomatic relief of ascites, even in the geriatric population. Finally, as noted previously, advanced age is no longer to be considered an absolute contraindication for liver transplantation. The evaluation of liver disease in the elderly may be diagnostically challenging, and its treatment rewarding.

Aged↗
PubMed1990

Usefulness of semiquantitative analysis of dipyridamole-thallium-201 redistribution for improving risk stratification before vascular surgery.

Preoperative dipyridamole-thallium-201 scanning is sensitive in identifying patients prone to ischemic cardiac complications after vascular surgery, but most patients with redistribution do not have an event after surgery. Therefore, its positive predictive value is limited. To determine which patients with thallium redistribution are at highest risk, dipyridamole-thallium-201 images were interpreted semiquantitatively. Sixty-two consecutive patients with redistribution on preoperative dipyridamole-thallium-201 planar imaging studies were identified. Each thallium scan was then analyzed independently by 2 observers for the number of myocardial segments out of 15, the number of thallium views out of 3 and the number of coronary artery territories with redistribution. Seventeen patients (27%) had postoperative ischemic events, including unstable angina pectoris, ischemic pulmonary edema, myocardial infarction and cardiac death. Thallium predictors of ischemic operative complications included thallium redistribution greater than or equal to 4 myocardial segments (p = 0.03), greater than or equal to 2 of the 3 planar views (p = 0.005) and greater than or equal to 2 coronary territories (p = 0.007). No patient with redistribution in only 1 view had an ischemic event (0 of 15). Thus, determining the extent of redistribution by dipyridamole-thallium-201 scanning improves risk stratification before vascular surgery. Patients with greater numbers of myocardial segments and greater numbers of coronary territories showing thallium-201 redistribution are at higher risk for ischemic cardiac complications. In contrast, when the extent of thallium redistribution is limited, there is a lower risk despite the presence of redistribution.

Aged↗
PubMed1989

Octogenarians with aortic stenosis. Outcome after aortic valve replacement.

To assess the outcome of aortic valve replacement for aortic stenosis in octogenarians, we retrospectively studied 64 patients, aged 80-89 years, who underwent aortic valve replacement for aortic stenosis from 1974 to 1987. Mean aortic valve gradient was 61 +/- 22 mm Hg, and valve area was 0.5 +/- 0.2 cm2. Concurrent coronary artery bypass grafting was performed in 29 patients, mitral valve replacement in two, and both procedures in two. Serious, comorbid, noncardiac conditions were infrequent. In-hospital mortality was 9.4%. Outcomes were classified as 1a) uncomplicated; 1b) complicated (technically complicated surgery, temporary encephalopathy, discharge to a rehabilitation facility, or some combination thereof) but with ultimately good results; or 2) unfavorable (death or permanent, severe neurological deficit). There were 28 (44%) patients in group 1a, 24 (38%) in group 1b, and 12 (19%) in group 2. Of 18 patients with preoperative left ventricular ejection fraction less than 50%, two (11%) were in group 2. Of 31 patients undergoing aortic valve replacement only, two (6%) were in group 2, compared with 10 of 33 (30%) patients who had concomitant coronary artery bypass grafting, mitral valve replacement, or both (p = 0.02). Late follow-up at 28 +/- 5 months revealed four cardiac and seven noncardiac deaths, with actuarial 1- and 5-year survival rates of 83 +/- 5% and 67 +/- 10%, respectively. With few exceptions, survivors were free of cardiac symptoms. Thus, short- and long-term outcomes after aortic valve replacement for aortic stenosis in otherwise healthy octogenarians is generally favorable, even in the presence of preoperative left ventricular systolic dysfunction.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed1979

Monoclonal antibodies reacting with murine teratocarcinoma cells.

Monoclonal antibodies were produced in vitro by fusing mouse myeloma cells with spleen cells from a rat immunized with the C3H mouse teratocarcinoma C86-S1. After the fusion two clones were chosen for further analysis. The first clone, 3C4-10, produced an antibody recognizing an antigen with a distribution restricted to teratocarcinoma cell lines, an endoderm cell line, and a neuroblastoma. The second clone, 4A1-9, produced an antibody that reacted with all cultured murine cells tested and adult brain. Neither antibody reacted with preimplantation embryos. The 3C4-10 antibody recognized an antigen associated with proteins. The apparent molecular weight of the 3C4-10 antigen was greater than 100,000.

Animals↗
PubMed1979

Assay for antibody mediated cytotoxicity of mouse spermatozoa by 86rubidium release.

The analysis of the antigenic structure of murine spermatozoa has been hampered by the lack of a convenient objective serological assay. Spermatozoa, in common with other cells, are capable of concentrating 86rubidium. Antibody mediated complement dependent cytotoxicity of murine spermatozoa has been quantitated by measuring release of 86rubidium from pre-labeled spermatozoa. We have used this assay to study the murine T/t locus.

Animals↗
PubMed1976

Murine t factors: an association between alleles at t and at H-2.

Lymphocytes from tx-mutant mice have a definite and consistent pattern of reactivity in MLR. Cells from t-mutant mice within a complementation group usually fail to stimulate each other, while cells from mutants in different complementation groups stimulate each other strongly. This indicates that tx-mutant types are associated with certain H-2 haplotypes, and that members of any give complementation group share the same H-2 haplotype.

Animals↗
PubMedDate not supplied

Analysis of anti-sperm sera for T/t locus-specific antibody.

An objective antiglobulin radioimmunoassay for the analysis of anti-spermatozoa antisera has been used to characterize more than 30 alloantisera. Each of these antisera was raised against spermatozoa from mice carrying T/t regin mutations. Whilst all of the antisera had considerable activity for mouse spermatozoa, none of them was found to contain antibodies specific for T/t region gene products. A detailed analysis of a single serum revealed that its activity is for antigens which are non-polymorphic, sperm-specific and species-specific. The failure in this study to detect antibodies specific for T/t region gene products is discussed.

Absorption↗