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Biomedical subjects

D Levy

Publications and source records attributed to D Levy.

At least 487 records · Page 27Linked to original sources
PubMedDate not supplied

Sustained improvement in flow-mediated vasodilation after short-term administration of dobutamine in patients with severe congestive heart failure.

BACKGROUND: In patients with severe congestive heart failure (CHF), short-term administration of dobutamine exerts sustained clinical benefits that are partially mediated by a training-like effect on skeletal muscle. Recently, physical training has been shown to enhance endothelial function in the skeletal muscle vasculature by improving endothelial function. Whether the dobutamine-induced training effect is also associated with an improvement in endothelial function in the skeletal muscle vasculature is currently unknown. METHODS AND RESULTS: Flow-mediated vasodilation in response to peak reactive hyperemia was evaluated in the forearms of 9 patients with severe CHF who were treated with dobutamine for 72 hours. Resting and peak hyperemic brachial artery blood flow and diameter (BABF [mL/min] and BAD [mm], respectively) were measured by 2-dimensional and Doppler ultrasonography at baseline, at 3 and 72 hours during dobutamine infusion, and at 2 and 4 weeks after discontinuation of dobutamine therapy. In addition, the brachial artery response to sublingual (SL) administration of nitroglycerin (NTG) was evaluated at baseline and at 2 and 4 weeks after discontinuation of dobutamine therapy. Ten patients with severe CHF who did not receive dobutamine served as control subjects. Resting BABF was significantly increased at 3 and 72 hours (391.2+/-31.8 and 366.8+/-31.0 mL/min, respectively, compared with 289.8+/-18.6 mL/min at baseline; P<0.05). Peak hyperemic BABF was not altered by dobutamine infusion compared with baseline values. The increase in BAD during peak hyperemic response was greater after infusion of dobutamine for 72 hours (15.2+/-2.7% versus 9.1+/-1.8%, P<0.05) and remained significantly greater for >/=2 weeks after discontinuation of dobutamine (12.3+/-2.2% versus 9.1+/-1.8%, P<0.05). In contrast to the peak hyperemic response, the increase in BAD (%) induced by SL NTG was unchanged by administration of dobutamine for 72 hours. Two and 4 weeks after discontinuation of dobutamine, NTG-induced increases in BAD were similar to the BAD noted at baseline. CONCLUSIONS: In patients with severe CHF, short-term administration of dobutamine for 72 hours selectively improves vascular endothelial function for >/=2 weeks.

Blood Flow Velocity↗
PubMedDate not supplied

Factors related to amphotericin-B-induced rigors (shivering)

Amphotericin-B is the only parenteral agent currently available to treat systemic fungal infections. Pyrogenesis, accompanied by severe shivering, is a distressing side effect. Possible risk factors of developing this reaction have not been reported. A case series was developed to document the occurrence and duration of shivering in patients who received amphotericin-B and to investigate whether these responses were associated with a diagnosis of diabetes mellitus, receipt of insulin or beta blockers, the amount of body fat content, an immunocompromised state, age, and gender. Medical records were reviewed and abstracted for patients who received 20 milligrams or more of amphotericin-B per day for at least 10 consecutive days between January 1, 1984, and September 1, 1988. Results indicated that a diagnosis of diabetes, insulin therapy, and advancing age were inversely associated with the amphotericin-B-induced rigors response. Shivering was noted to occur first at the test dose, with the percentage of patients who shivered increasing with each successive dose (this peaked at the fifth therapeutic dosage). Of the factors under study, only advancing age appeared to be related to the duration of shivering. It is possible that identification of the descriptive characteristics of amphotericin-B-induced rigors will facilitate the nursing care of patients who receive this treatment; it also may be an important first step in the identification of risk factors for this clinical complication.

Adipose Tissue↗
PubMedDate not supplied

Impact of an educational program on physician cancer control knowledge and activities.

Continuing medical education (CME) programs are a common way for physicians to keep up with new developments in medical care. CME has been criticized as poorly evaluated at best and ineffective at worst. Proposed modifications in the traditional CME format include a role for influential peers, physician discussion groups, and self-formulated contracts. As part of a project that is testing methods to improve primary care physician cancer control performance, we provided an eight-hour educational program that included these proposed modifications and that addressed early detection of breast, cervical, and colon cancer and counseling on nutrition and smoking cessation. Physician knowledge improved after the program in four of the five content areas. In addition, physicians reported significant increases in their cancer control activities after six months. We conclude that cancer control CME programs that use interactive discussion groups, influential peers, and self-formulated contracts are feasible, well received by physicians, and result in improvements in knowledge and self-reported cancer control behavior.

Education, Medical, Continuing↗
PubMedDate not supplied

[Gastric tuberculosis. Apropos of a recent case report recorded in Abidjan].

The authors describe a case of gastric tuberculosis in a 23 years old African patient from Abidjan. Symptomatology included epigastralgia, post prandial vomiting, severe impoverishment of health state and dehydration. Endoscopy showed a pseudopolypoid diffuse gastritis with an infiltrated like mucosa. Endoscopic biopsy was carried out, but, because of clinical aggravation (epigastric muscular defense), the patient underwent a laparotomy before knowing the results of the biopsy. Gastrotomy showed an hypertrophied granulomatous hemorrhagic mucosa. By histological examination it was concluded in favour of a granulomatous gastritis with pan-parietal tuberculoid lesions without acid-alcohol-fast bacilli. The different causes of granulomatous gastritis were reviewed and a tuberculous etiology suspected. An antituberculous therapy was prescribed with excellent results on clinical and endoscopic standpoint one year after the treatment started.

Adult↗
PubMedDate not supplied

The progression from hypertension to congestive heart failure.

OBJECTIVES: - To study the relative and population-attributable risks of hypertension for the development of congestive heart failure (CHF), to assess the time course of progression from hypertension to CHF, and to identify risk factors that contribute to the development of overt heart failure in hypertensive subjects. DESIGN: - Inception cohort study. SETTING: - General community. PARTICIPANTS: - Original Framingham Heart Study and Framingham Offspring Study participants aged 40 to 89 years and free of CHF. To reflect more contemporary experience, the starting point of this study was January 1, 1970. EXPOSURE MEASURES: - Hypertension (blood pressure of at least 140 mm Hg systolic or 90 mm Hg diastolic or current use of medications for treatment of high blood pressure) and other potential CHF risk factors were assessed at periodic clinic examinations. OUTCOME MEASURE: - The development of CHF. RESULTS: - A total of 5143 eligible subjects contributed 72422 person-years of observation. During up to 20.1 years of follow-up (mean, 14.1 years), there were 392 new cases of heart failure; in 91% (357/392), hypertension antedated the development of heart failure. Adjusting for age and heart failure risk factors in proportional hazards regression models, the hazard for developing heart failure in hypertensive compared with normotensive subjects was about 2-fold in men and 3-fold in women. Multivariable analyses revealed that hypertension had a high population-attributable risk for CHF, accounting for 39% of cases in men and 59% in women. Among hypertensive subjects, myocardial infarction, diabetes, left ventricular hypertrophy, and valvular heart disease were predictive of increased risk for CHF in both sexes. Survival following the onset of hypertensive CHF was bleak; only 24% of men and 31% of women survived 5 years. CONCLUSIONS: - Hypertension was the most common risk factor for CHF, and it contributed a large proportion of heart failure cases in this population-based sample. Preventive strategies directed toward earlier and more aggressive blood pressure control are likely to offer the greatest promise for reducing the incidence of CHF and its associated mortality.

Adult↗