Biomedical subjects

M H Levy

Publications and source records attributed to M H Levy.

At least 19 recordsLinked to original sources

PubMed1992

Mycobacterial disease and AIDS in New South Wales.

OBJECTIVE: To determine the coincidence of mycobacterial disease and acquired immunodeficiency syndrome (AIDS), and whether persons with mycobacterial disease and human immunodeficiency virus (HIV) infection differ from those with mycobacterial disease alone, by age, sex and country of birth. DESIGN: A descriptive study. PARTICIPANTS: Persons on the NSW Tuberculosis Register in 1989 and those on the NSW AIDS database in 1982-1989. MAIN OUTCOME MEASURE: Coincident appearance on the Tuberculosis Register and the AIDS database. RESULTS: People with atypical mycobacterial infection and HIV infection were younger and more likely to be male compared with those with mycobacterial disease alone. There was a strong association between mycobacterial disease and HIV infection. Of 438 patients newly diagnosed with mycobacterial disease in 1989, 75 (17.1%) had HIV infection. Of 318 tuberculosis patients, 8 (2.5%) had HIV infection, and of 120 patients with atypical mycobacterial infection, 67 (55.8%) had HIV infection. CONCLUSION: Close monitoring of HIV patients for mycobacterial infection, and chemoprophylaxis for persons infected with HIV who have positive Mantoux test results will assist in the control of mycobacterial disease. HIV testing and counselling should be considered for all persons with mycobacterial disease.

Acquired Immunodeficiency Syndrome↗

PubMed1992

Rabies case in New South Wales, 1990: public health aspects.

OBJECTIVES: To identify the source of rabies in the recent case in New South Wales, and to determine the need for post-exposure rabies prophylaxis among contacts of the patient. DESIGN: Information was obtained by face-to-face interview of the dead girl's family and face-to-face and telephone interviews using a questionnaire of health care workers. Other information was gathered from overseas and local sources through telephone and facsimile contact. RESULTS: The girl had migrated from Vietnam in 1984 to Hong Kong, and from there in 1986 to Australia. No evidence of contact with a rabid animal in Australia or Hong Kong was found. There had also been no organ donations from the girl. Four health care workers were given post-exposure rabies prophylaxis. CONCLUSIONS: Because of the lack of evidence of animal contact in Australia and the fact that extremely long incubation periods for rabies have been documented, it was considered that the most likely source of the rabies virus was North Vietnam. Genetic studies of the virus also supported a South-East Asian source. Nevertheless the presumed incubation period--at least six years and four months--is one of the longest recorded.

Animals↗

PubMed1992

Transdermal fentanyl: seeding trial in patients with chronic cancer pain.

In this study, 6 patients with pain from advanced cancer were enrolled in a multicenter, open-label seeding trial of transdermal fentanyl. Following equianalgesic dose conversion, transdermal fentanyl patches were applied every 3 days. Mean fentanyl dosage doubled by week 2 and tripled by week 4. Pain control improved in all patients. There were no significant changes in mood, constipation, nausea, sedation, daily activities, or interpersonal relationships from pretrial to posttrial analyses. Following the study period, 5 patients were monitored for a mean total of 55 days with a mean final fentanyl dose of 240 micrograms/hr. As part of a comprehensive cancer pain management program, transdermal fentanyl appears to be safe and effective, and should prove to be a useful addition to currently available opioid analgesics.

Administration, Cutaneous↗

PubMed1992

The role of patient education in cancer pain control.

Patient education should be a central component of pain control regimens for cancer patients. Few systematically developed and carefully evaluated pain control patient education programs have been reported. Patient education for cancer pain control should include five phases: assessment, goal setting, selection of educational strategies, implementation and reassessment. Each of these phases should be included to maximize the goals of pain prevention and pain relief.

Humans↗

PubMed1991

Phase II study of weekly 5-fluorouracil, cisplatin and vinblastine in advanced non-small cell lung cancer.

The scheduling of chemotherapeutic agents may be important in optimising their antitumour actions. This has been explored in non-Hodgkin lymphoma, osteogenic sarcoma and bladder cancer with improved results using intensive, weekly dosing schemas. We began a phase II study of cisplatin, 5-fluorouracil and vinblastine in non-small cell lung cancer (NSCLC) on a weekly schedule. 38 patients with advanced or metastatic NSCLC were entered; 32 are evaluable for response. 11 patients were treated with 5-fluorouracil 1.5 g/m2 and vinblastine 4 mg/m2 by 24-h continuous infusion, and cisplatin 30 mg/m2 over 30 min, 6-8 h after the start of the infusion. Because of prohibitive myelotoxicity, the next 27 patients received 5-fluorouracil 1.2 g/m2 and vinblastine 3 mg/m2. None had had prior chemotherapy while 6 had had previous radiation therapy. Myelosuppression was the predominant toxic effect. Other side-effects included neuropathy, diarrhoea, mucositis, nausea and vomiting. 32 patients are evaluable for response: there have been 14 partial remissions (44%). Responses have occurred chiefly in lung and lymph nodes. The median survival on this study is 7 months, and responders did not live longer than non-responders. While this regimen is well tolerated by the majority of patients and has a response rate comparable to other active regimens identified in single institution studies, survival does not appear to be enhanced. We conclude that the schedule manipulation described here does not enhance the therapeutic index of these drugs in NSCLC.

Adult↗

PubMed1991

Reported measles immunisation and serological immunity in children attending general practitioners.

To determine the feasibility of serological testing for measles immunity in children attending general practitioners and to assess the validity of establishing immune status by reported immunisation history compared with serology, a cross-sectional descriptive study was conducted in general practices in the Illawarra area south of Sydney, New South Wales. Participants were 234 children under 15 years attending general practitioners. 87 per cent of children were reported to have been immunised against measles, but 46 per cent of these children were seronegative for measles antibody using an ELISA test on finger-prick blood. This could not be explained by inaccurate reporting of immunisation. No causes other than failure to seroconvert or inadequate specificity of the test on the blood samples were evident. Failure to seroconvert as a result of inadequate adherence to cold chain requirements is a possibility that needs further investigation. The results further question whether a single vaccination is adequate to achieve the public health aims of measles immunisation programs.

Adolescent↗

PubMed1991

Effective integration of pain management into comprehensive cancer care.

Pain management is an integral component of comprehensive cancer care. The combined goals of optimal comfort and optimal function require a working understanding of how pain therapy interacts with cancer and cancer therapy. The two main aspects of cancer which affect pain management are the cancer's treatability and its non-pain pathophysiology. Cancer treatability determines the importance of pain management and the appropriateness of invasive pain-blocking procedures. Cancer non-pain pathophysiology often hinders pain control by preventing oral administration of medications, narrowing a patient's therapeutic window for opioid analgesics, limiting psychological therapies, and interfering with invasive pain relieving procedures. Cancer therapy can impair or enhance pain therapy and vice versa. Cancer therapy can impair pain therapy by its production of adverse effects or by its direct causation of pain. Cancer therapy can enhance pain therapy by reducing the amount of cancer, by including drugs which act as coanalgesics, and by providing intravenous access devices for parenteral opioid administration. Pain therapy can impair cancer therapy by augmenting or complicating cancer therapy's adverse effects. Pain therapy can enhance cancer therapy by improving organ function and patient performance status permitting previously limited or contraindicated cancer therapies to be given. Five case studies are presented to illustrate how effective integration of pain management into comprehensive cancer care is mandatory for optimal care of cancer patients and their families.

Female↗

PubMed1990

"Just one shot" is not enough--measles control and eradication.

The epidemiology of measles in Australia has changed in the last decade due to control of the disease by increased immunization rates. Elimination of endemic measles is possible, but has still to be attempted. A partially immunized population results in disease in an older population, with the possibility of contracting measles in the childbearing years. For elimination of measles to occur, a second dose of measles-mumps-rubella vaccine should be introduced. Changes in the immunization protocol would need to be monitored with reliable population-based data on seroconversion rates and disease incidence. Reliable documentation of immunization is a prerequisite for any legislative initiative in the field of immunization. In order to maximize the impact of immunization programmes, the social and cultural contexts within which immunization occurs should receive greater consideration.

Adolescent↗

PubMed1989

Integration of pain management into comprehensive cancer care.

Pain management is an integral component of comprehensive cancer care. Designing an effective pain control strategy for the individual patient requires knowledge of the ways in which a patient's cancer, cancer therapy, and pain therapy can interact. Two important aspects of cancer that affect the way in which pain is managed are the cancer's treatability and components of its pathophysiology that themselves do not cause pain (the cancer's "nonpain" pathophysiology). Cancer treatability modifies the need for pain management and the appropriateness of invasive pain procedures. Cancer nonpain pathophysiology can interfere with the oral administration of medications, narrow the patient's therapeutic window for analgesic drugs, limit the effectiveness of psychologic pain therapies, and complicate or preclude invasive pain-relieving procedures. In addition, cancer therapy can interfere with or enhance pain therapy and vice versa. Cancer therapy can interfere with pain therapy by causing pain or by producing other adverse effects. Cancer therapy can enhance pain therapy by reducing the extent of cancer, by acting as a coanalgesic, and by providing intravenous access for parenteral drug administration to patients who require it. Pain therapy can interfere with cancer therapy by increasing or complicating the adverse effects of cancer therapy. Pain therapy can enhance cancer therapy by improving patient performance, and certain palliative surgical procedures may have the ancillary effect of improving organ function. Five case descriptions are presented as illustrations of effective integration of pain management into comprehensive cancer care.

Adenocarcinoma↗

PubMed1989

Pain control in breast cancer. A panel discussion.

Pain can be a prominent finding in breast cancer patients. It may occur in the setting of the postmastectomy period, related to the disruption of normal neural pathways or the development of lymphedema. In advanced disease, the management of pain from nerve compression or bone metastases requires special approaches. In this panel discussion, the participating physicians will discuss these topics and provide an up-to-date approach to pain control in breast cancer patients.

Analgesics, Opioid↗

PubMed1989

Bilateral idiopathic inflammation of the optic nerve sheaths. Light and electron microscopic findings.

Idiopathic perioptic neuritis is a term used to describe noninfectious inflammatory disorders of the optic nerve sheaths, the causes of which are unknown. In the following report, a 68-year-old woman with bilateral visual loss was found to have chronic inflammation with necrobiotic granulomas of her optic nerve sheaths. The patient, who had no systemic condition known to be associated with necrobiotic granuloma, lost vision from infarction of the optic nerve parenchyma and from compression due to thickened meninges. Although there are similarities between the inflammatory reaction in this case to the necrobiotic dermatoses, the pathogenesis of this condition remains obscure.

Aged↗

PubMed1988