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Biomedical subjects

B Levin

Publications and source records attributed to B Levin.

At least 289 records · Page 16Linked to original sources
PubMed1981

Effect of pharmacist intervention on the use of serum drug assays.

The results of an investigation to (1) evaluate the use of serum drug assays (SDAs), (2) study the influence of clinical pharmacist monitoring and educational programs on SDA use, and (3) perform drug-related patient-care evaluations for the medical audit committee are reported. The components of the five-month study were a retrospective audit, education of physicians prescribing SDAs, and a concurrent reaudit. The four SDAs audited were digoxin, theophylline, gentamicin, and phenytoin. Criteria for appropriate use were defined by the audit committee and a clinical pharmacist. The criteria specified the indication for each drug, performance data, and dosage adjustments with SDA results. The clinical pharmacist presented two housestaff conferences on the appropriate use of SDAs and distributed educational materials to the attending physicians. An SDA report form was completed each time an SDA was ordered, and, whenever possible, the pharmacist met with the prescribing physician. Appropriate overall use of SDAs increased significantly (p less than 0.05). A significant improvement (p less than 0.05) was noted for each of the criteria. An estimated $2500 in patient charges was saved during the study; the cost of the clinical pharmacist's time was approximately $260. The authors concluded that clinical pharmacists, in conjunction with patient-care evaluations, can provide a cost-effective service in improving therapeutic patient monitoring based on SDA results.

Costs and Cost Analysis↗
PubMed1981

Dysplasia-associated lesion or mass (DALM) detected by colonoscopy in long-standing ulcerative colitis: an indication for colectomy.

In performing colonoscopy over a 4-yr period on 112 patients with long-standing ulcerative colitis, a dysplasia-associated lesion or mass (DALM) was found in 12. This appeared as either a single polypoid mass (5 cases), a plaquelike lesion (2 cases), or multiple polyps (5 cases). In 7 of these 12 cases carcinoma was subsequently found. This was particularly true in the 5 cases of single polypoid masses where all 5 contained invasive carcinoma. In none of the cases associated with malignancy did multiple biopsies of the DALM reveal invasive carcinoma. In only 2 of the 7 patients with carcinoma was the dysplasia "severe," being "mild" or "moderate" in the remaining 5. In the 27 patients with dysplasia found incidentally in random biopsies of flat mucosa only one carcinoma was found, in contrast to the 7 cancers in 12 patients with DALM. This difference leads us to regard the finding of DALM, especially a single polypoid mass, as highly significant in patients with long-standing ulcerative colitis. It carries a sufficiently high risk of cancer, thereby constituting a strong indication for colectomy.

Adult↗
PubMed1980

5-fluorouracil, Adriamycin, and mitomycin-C (FAM) chemotherapy for advanced adenocarcinoma of the pancreas.

Thirty-nine patients with advanced metastatic adenocarcinoma of the pancreas were treated with a combination of 5-fluorouracil, Adriamycin, and mitomycin-C (FAM). Twenty-seven of these patients had measurable disease, and ten (37%) achieved a partial response. An additional three patients had evidence of disease stabilization. The median survival period of responding patients was 12 months, compared with 3.5 months for nonresponders (P < 0.01). The median survival period for all patients was 6 months. Moderate myelosuppression constituted the treatment-limiting toxicity. The FAM combination is an active and well-tolerated regimen for pancreatic cancer and may have an application in the management of patients with less advanced disease.

Adenocarcinoma↗
PubMed1980

Recurrent enteric gallstone obstruction.

Small bowel gallstone obstruction may recur, most often within a few days after surgery, due to an overlooked intraenteric stone or subsequent passage of another gallstone via the cholecystoenteric fistula. In the case reported herein there was a 6-month interval. A critical review of the radiologic signs of gallstone ileus is presented.

Aged↗
PubMed1980

Gastric adenocarcinoma following gastric lymphoma. Role of partial gastrectomy.

Gastric adenocarcinoma developed in a 45-year-old man 13 years after he had undergone resection of a gastric lymphoma (large cleaved cell type, diffuse) and two courses of radiation therapy to the upper abdomen to a total dose of 6300 rad. Three factors involved in possibly increasing risk for the second malignancy, namely lymphoma, extensive radiation therapy, and gastric resection, are discussed. Degenerative and premalignant histologic changes occur in the gastric remnant after partial gastrectomy. These contribute to the pathogenesis of adenocarcinoma after surgical therapy of peptic ulcer or other disorders. Periodic endoscopic surveillance and the use of multiple biopsies are important in achieving early diagnosis.

Adenocarcinoma↗
PubMed1980

Crohn's disease and adenocarcinoma of the bowel.

We present six cases of cancer associated with Crohn's disease and stress the importance of the earlier age of onset than spontaneously arising small-bowel carcinoma, the long period of latency from the time of diagnosis of Crohn's disease to that of carcinoma, and the generally poor prognosis. We emphasize, furthermore, the frequent association with fistulas and the predisposition of bypassed or excluded segments of bowel to undergo malignant transformation. The occurrence of carcinoma in an excluded rectal stump has not previously been reported and stresses the necessity of resecting, rather than excluding, segments of bowel involved with Crohn's disease. These tumors are often not readily apparent by radiographic or endoscopic examination and in fact, may be discovered only after microscopic examination of resected or biopsied tissue.

Adenocarcinoma↗
PubMed1980

Double minutes in human large bowel cancer.

Two patients with large bowel carcinoma are described in whose tumors the presence of double minutes was observed. In one of these, the first such patient to be reported, double minutes were present in 100% of metaphases examined in both the primary tumor and its liver metastasis. The number of double minutes varied from 6 to 93 per metaphase. In the second patient, double minutes were seen only in two metaphases. The literature on double minutes is summarized, and it is concluded that double minutes are found in a wide spectrum of tumors, including human large bowel cancer and are not confined to tumors of neurogenic origin as suggested by earlier workers. In additon, evidence is suggestive of an association between the lack of differentiation and the presence of double minutes, but further data are required to substantiate this.

Adenocarcinoma↗
PubMed1979

Chromosome analysis of primary large bowel tumors: a new method for improving the yield of analyzable metaphases.

Colon tumors were processed immediately after surgical resection. Using L-Arterenol and sodium citrate in combination with standard chromosome culture techniques, 12 of 17 consecutive tumors (75%) had countable figures ranging from 5 cells to 59 cells. Seven of the 12 cases had over 25 countable cells. Chromosome counts did not vary more than +/- 4 for any one case. Seven tumors were karyotyped, 6 with banding techniques. One of these specimens had mosaic patterns. The chromosome counts varied: 2 were hypodiploid; 1 was pseudodiploid and 4 were hyperdyploid. There were some similarities in the karotypes although no identical karyotypes were seen in this series.

Adenocarcinoma↗
PubMed1979

Urinary diversion for ureteral obstruction in the presence of recurrent colon carcinoma.

Selection of patients who might benefit from urinary diversion when recurrent colorectal cancer obstructs both ureters is difficult. Combinations of chemotherapy and radiation therapy will prolong a useful, comfortable and dignified life in some patients. Radiation therapy seems to be more effective than chemotherapy and, therefore, patients most likely to benefit are those with localized pelvic recurrences without carcinomatosis and those who are well nourished, active and highly motivated. Herein we discuss 6 patients who were diverted and the methods of selection.

Colonic Neoplasms↗
PubMed1979

Stressbreakers: a practical approach.

The use of stressbreakers for removable partial dentures will doubtless continue to be controversial. Most of the data available for guidance are clinical trials and observations. It is not reasonable to expect a 100 per cent success rate for any biomechanical device. All available designs should be considered in order to choose the right treatment for the situation. When indicated and correctly executed, the 12-gauge chrome wire and the split palate stressbreakers have proved to be practical adjuncts to our treatment armamentarium.

Dental Stress Analysis↗
PubMed1979

Dietary fiber.

It is obvious that the effects of fiber on colonic functions are complex. The typical "Western diet" which is high in fat and protein and low in fiber may alter the bacterial flora and milieu interieur of the gastrointestinal tract, particularly the colon, to produce a high incidence of colonic cancer. However, the exact nature of the interrelationships between these dietary constituents remains elusive and will undoubtedly be the subject of intense investigation in years to come.

Animals↗
PubMed1979

Stricture of the esophagogastric junction with adjacent extraluminal cavity following radiation.

We report a radiation stricture of the esophagogastric junction with an adjacent extraluminal cavity formed secondary to radiation in a patient receiving 4,500 rads for a histiocytic lymphoma of the stomach. We suggest that the presence of a radiosensitive lymphoma may have undermined the normal reparative response to radiation of the esophagogastric junction and predisposed it to stricture and cavity formation at this dose of radiation.

Aged↗
PubMed1978

Radiological detection of colonic dysplasia (precarcinoma) in chronic ulcerative colitis.

Epithelial dysplasia occurring in long-standing ulcerative colitis is a precancerous lesion. Macroscopically it has a nodular or villous appearance or may be indistinguishable from the surrounding mucosa. An investigation into the radiological diagnosis of dysplasia, using in vivo and in vitro double-contrast examinations with magnification radiographic studies, correlated with the histological analysis, has been made in four patients. Characteristic radiological abnormalities have been identified in the areas of the mucosa associated with histologically proven dysplasia. These appearances include nodularity and irregular areas with sharply angulated edges which may represent enlarged areae colonicae. The demonstration of these changes is an indication for endoscopic examination and biopsy of the suspicious area.

Adult↗