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Biomedical subjects

L B Reichman

Publications and source records attributed to L B Reichman.

At least 19 recordsLinked to original sources
PubMed1992

Liver transplantation: an unheralded probable risk for tuberculosis.

We present a patient who underwent orthotopic liver transplantation and died of previously undiagnosed pulmonary tuberculosis (TB). TB is known to complicate liver transplantation in rare circumstances. Liver transplantation is an unheralded risk factor for development of TB because of possible activation of latent infection or primary TB in immunosuppressed hosts. A tuberculin skin test should always be performed preoperatively. Preventive treatment with isoniazid is indicated when immunosuppressive therapy is started in patients with high TB risk. Radiographic signs of previous granulomatous disease may be important when tuberculin skin test is negative, unknown or anergy is present. TB is preventable--with a high degree of suspicion where TB is endemic and proactive programs, most TB cases in transplant recipients can be avoided.

Adult↗
PubMed1992

Long-term follow-up of tuberculoma of the brain in an AIDS patient.

Human immunodeficiency virus infection and extrapulmonary TB are defined as AIDS. The clinical manifestations of the TB are related to the interplay of the organism and the host's immune system. A seven-year follow-up of a woman successfully treated for biopsy- and culture-documented tuberculous brain abscess is described. Antibodies to HIV have been positive on repeated testing, yet CD4 counts remain over 500. Aggressive diagnostic and therapeutic maneuvers for all forms of TB in AIDS are warranted since long-term prognosis may be good.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Isoniazid preventive therapy for tuberculosis. Decision analysis considering ethnicity and gender.

The decision to prescribe or withhold isoniazid (INH) preventive therapy for low-risk tuberculin reactors has been highly controversial, primarily due to isoniazid's possible hepatotoxic effects. Previous analyses have explored the INH decision only from the perspective of patient age, recognizing that the risks of INH-induced hepatotoxicity are age related. Decision analyses presented in this paper assess the impact of gender and ethnic group, as well as age, on the INH decision. Results for low-risk patients favor prescribing INH preventive therapy for all 20-yr-olds, all 35-yr-olds except black women, and no 50-yr-olds, projecting life expectancy benefits that range from 3 to 19 days. A comparison set of analyses performed for high-risk patients favors prescribing INH for all groups except 50-yr-old black women. These findings suggest that ethnicity, gender, and age should be considered when making the decision to prescribe or withhold INH preventive therapy.

Adult↗
PubMed1979

Relationship of static respiratory muscle pressure and maximum voluntary ventilation in normal subjects.

40 normal subjects performed spirometry, maximum voluntary ventilation (MVV), and tests of static inspiratory (Pi max) and expiratory (Pe max) respiratory muscle pressure. Forced expiratory volumes in 0.5 (FEV0.5), in 0.75 (FEV0.75), and 1 sec (FEV1) correlated significantly with MVV (r = 0.805, 0.804, 0.779, respectively). When Pi max was considered as a second independent variable, the probability of predicting MVV from timed forced expiratory volumes was enhanced (r = 0.914, 0.900 and 0.872 for FEV0.5, FEV0.75, and FEV1, respectively). Statistical analysis indicated that multiple regression with Pi max was superior to regression with timed forced expiratory volume alone in the prediction of MVV. For any given FEV1, however, Pi max was widely dispersed (range: -60 to -200 cm H2O). MVV values, expressed as percentage difference between largest and smallest value, varied less than did Pi max. Pe max, vital capacity, height and age did not enhance the ability of timed forced expiratory volumes to predict MVV. These data indicate that while respiratory muscle strength is important for sustaining maximal ventilation, the MVV is not a sensitive indicator of respiratory muscle strength.

Adult↗
PubMed1979

Drug dependence, a possible new risk factor for tuberculosis disease.

A study was performed to assess the risk of drug-dependent persons for developing tuberculosis. Tuberculosis prevalence was 3,740/100,000 drug-dependent inpatients compared with 584/100,000 non-drug-dependent discharges. In another program, prevalence was 3,750/100,000; in the New York Methadone Program, prevalence was 2,652/100,000 patients in Harlem and 1,372/100,000 city-wide. The city-wide prevalence rate in the entire population was 86.7/100,000 in 1971 and 64.7/100,000 in 1973. Similar elevations in incidence also were found in drug-dependent vs non-drug-dependent populations. Our data show that disease rate is elevated in drug-dependent populations, suggesting that drug dependency reflects a high-risk situation for tuberculous infected individuals developing tuberculosis disease. We suggest that infected drug-dependent persons (tuberculin positive) be considered for preventive therapy with isoniazid, which can be piggybacked onto a drug treatment program.

Humans↗
PubMed1978

Tuberculous infection in a large urban population.

A positive tuberculin reaction, which indicates tuberculous infection, is known to correlate with increased rates of tuberculous disease, but current data concerning possible relationships with factors such as ethnic group, socioeconomic status, age, and sex are unpublished or unavailable. Current background rates of tuberculous infection are also generally not available, so that expected prevalence rates of tuberculous infection in urban areas have not been confidently established. In 1973/74, the New York City Health Code presented an opportunity to study these factors in more than 50,000 employees of the Board of Education. For the first time, a specific index was used to quantitate socioeconomic status. The relative effect of each of these variables on reactor rate was measured. It was found that tuberculous infection was related to race or ethnic group, socioeconomic status, age, and sex, in that order. The over-all data presented a recent picture of the prevalence of tuberculous infection in an urban population.

Adult↗
PubMed1977

The influence of a history of a previous test on the prevalence and size of reactions to tuberculin.

Ten millimeters of more of induration to the Mantoux tuberculin test indicates present or past infection with Mycobacterium tuberculosis in the overwhelming majority of cases. Because a number of patients gave a history of a previous positive reaction that was not confirmed on retesting, we carefully evaluated, as part of a large tuberculin testing survey, 1,428 persons who claimed to have had a previous positive test. Of these, 606 (42.4 per cent) had a positive reaction on retesting. When compared to subjects with no history of a previous tuberculin test, this group had only a slightly higher percentage of large reactions (greater than 24 mm). The difference was not significant. This discrepancy between history and test results cannot be assumed to be due to technique or to anergy in the current testing because of appropriate controls. It probably reflects variability in the use of antigens, technique at the previous testing, or faulty recollection of the subject. Because presumption of tuberculosis infection may lead to further diagnostic or therapeutic decisions, it is recommended that all skin test histories be documented or confirmed by retest before consideration of further examinations or therapy. In those with a history of a previous reaction, very large reactions (greater than 24 mm) were only slightly more frequent (but not to a significant degree) than those without such a history; thus, a previous reaction history should not be sufficient to preclude retesting.

Adult↗