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Biomedical subjects

E Levy

Publications and source records attributed to E Levy.

At least 217 records · Page 12Linked to original sources
PubMed1989

[Acute necroticohemorrhagic pancreatitis. Why, when and how to drain? Apropos of 106 cases].

The heavy toll of necrotizing acute pancreatitis led the authors to start developing a new method of treatment in experimental and clinical conditions in 1979. This was aimed on one hand at creating a large channel for the centrifugal drainage of pancreatic or peri-pancreatic foci, and on the other hand at maintaining this draining channel during the first 5 weeks of acute evolution of the acute necrotizing pancreatitis in order to allow the permanent evacuation of purulent or necrotic fragments. From 1979 to 1989, 106 patients were treated with this method, ie. 71 men and 35 women with an average age of 47.9 years. 73 (74%) of these patients had been referred by other hospitals, and 64 only had been initially operated at Saint-Antoine hospital. All patients presented with extensive peripancreatic necrosis. The average Ranson score was 4.8 (not taking the fluid sequestration during the first few hours into account). Visceral failure was observed in 76% of the patients before surgery. The necrosis of the pancreatic gland was focal in 6 cases, extensive in 47 cases and total or subtotal in 25 cases. Out of the 70 CT studies, 64 showed a Ranson grade of E. All patients received enteral feeding on a jejunal site postoperatively. The mortality rate was 16%. The stay of the surviving patients in the intensive care unit averaged 50 days. 29 patients (27%) were reoperated on for complications or insufficient drainage.

Adult↗
PubMed1989

[Total cutaneous electron beam therapy of mycosis fungoides].

Electron beam irradiation of the entire skin surface was used to treat 25 patients with mycosis fungoides from 1977 to January 1988. A plexiglas screen was used to reduce the energy of the 8 MeV beam of a Sagittaire linear accelerator to 4 MeV. A total dose of 30 Gy was delivered in 12 fractions over days. This series includes 17 men and 8 women with a mean age of 44 years (range 13-78 years) and a mean follow-up of 34 months (range 6-92 months). The following-up staging system was used: stage A: superficial lesions covering less than 50 p. 100 of the body surface; stage B: superficial lesions covering more than 50 p. 100 of the body surface; stage C: tumors of the skin, lymph nodes and/or visceral organs, Sezary's syndrome. All stage A patients achieved complete remission. One developed recurrent disease in a very limited area 17 months after radiation therapy. No stage A patient died of mycosis fungoides. 6/9 stage B patients achieved complete remission; 4 of these developed recurrent disease localized to the skin 6 to 13 months after electron therapy. These recurrences were controlled by topical nitrogen mustard, puva therapy or localized irradiation. 1 patient showed no response and died of cutaneous mycosis fungoides. 5/10 stage C patients obtained complete remission but all relapsed within a mean period of 7 months. 4/5 of the patients not responding to electron therapy died of their disease and one is alive 16 months after completion of treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1989

[Radiotherapy of Kaposi's sarcoma in AIDS].

Between June 1986 and August 1988, 129 patients with AIDS-related Kaposi's sarcoma were treated by cutaneous irradiation in our department. According to Mitsuyasu's staging, 25 patients (19%) were stage 1.76 (59%) stage II, no stage III was reported and 28 (22%) stage IV. Fifty four patients (42%) had previously presented with one or multiple opportunistic infections. Eighty six (66%) had previously received treatment: by interferon in 80 patients (62%) and/or Velbe in 40 (31%). Seventy six patients (59%) were treated by extensive cutaneous irradiation using 4 and/or 8 MeV electron beam energy and 53 patients (41%) by localized irradiation using 45 kV X-ray energy, 2.5 Gy/fraction, 4 times/week by split course 20 Gy then 10 Gy two weeks later. Only 111 patients were evaluable; 61% obtained complete remission and 33% partial remission after a mean period of 1.5 months (0.5-3 months). The overall tolerance was acceptable. The complications were epidermitis with some necrosis (8%), exudative epidermitis (26%) moderate epidermitis (63%) and slight reactions in 4%. The mean recurrence time was 5 1/2 months.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Continuous enteral nutrition during the early adaptive stage of the short bowel syndrome.

Sixty-two patients with the short bowel syndrome (30-150 cm) were managed by continuous enteral nutrition (CEN) in the early adaptive phase. In all, 82 per cent were referrals from other units and 85 per cent of referrals had failure of one or more organ systems on admission. There were intra-abdominal abscesses in 41 per cent of patients and 37 per cent had an enterocutaneous fistula. The diet included polysaccharides, medium chain triglycerides and protein hydrolysates, mixed with a high-viscosity tapioca suspension. An elemental diet was used initially in 15 per cent of patients. Thirty-three patients had an interruption of the gastrointestinal tract by a temporary enterostomy. Chyme was re-infused into the distal intestine in 20 cases. 'Zero-time' was taken as the time of operation or, for referred patients treated conservatively, the date of admission. CEN was commenced at a mean of 14 days from zero-time. Total parenteral nutrition could be discontinued at a mean of 36 days and exclusive oral alimentation was resumed at a mean of 87 days. Patients with small bowel longer than 80 cm attained enteral autonomy earlier than patients with a shorter length. Mean faecal volume did not increase following institution of CEN, suggesting tolerance to the high-viscosity diet. In cases with re-infusion of enteric content, the distal circuit (length of distal small intestine 46 cm) was able to absorb 70 per cent of the volume re-infused (mean volume 2700 ml). Body weight and nutritional markers increased significantly during the course of CEN. This study suggests that enteral autonomy can be attained early in the short bowel syndrome, even under challenging conditions. Elemental formulae do not appear to offer a benefit over polymeric diets.

Adolescent↗
PubMed1988

The effect of various postphlebotomy storage conditions on drug levels.

Monitoring drug levels in patients is standard practice in presentday critical care medicine. Clinical laboratories, however, are often unable to assay drug levels immediately following phlebotomy. This may result in blood samples being kept under a variety of storage conditions for nonuniform periods of time. The current study evaluated the stability of eight frequently monitored medications and one of their metabolities, in whole blood and plasma, at 4 degrees C or 25 degrees C, for up to 72 hours. The drugs included antibiotics, a bronchodilator, antiarrhythmics, and an anticonvulsant. Significant changes in drug levels were not identified at the time points studied. Our data suggests that meticulous postphlebotomy handling of blood samples may not be essential to obtain accurate levels of the drugs studied.

Animals↗
PubMed1988

Lipid abnormalities in pancreatic tissue of streptozotocin-induced diabetic rats.

Pancreatic lipid and fatty acid composition was determined in streptozotocin-induced diabetic rats and compared to control and insulin-treated diabetic rats. A pronounced decrease of total fatty acids was recorded and mainly accounted for by a drop of fatty acids in glycerides. Cholesterol, on the other hand, was significantly increased two- to three-fold, leading to an elevated cholesterol/phospholipid ratio. Morpho-cytochemical studies confirmed these findings because the multiple lipid droplets present in acinar cells of diabetic animals were found to be of cholesterol nature. The major alterations in phospholipid-fatty acid composition were characterized by an increase of linoleate coupled to a decrease of monounsaturates and arachidonate, suggesting defective metabolism of saturates and of linoleate. This was further supported by fatty acid ratios that suggested low delta 5 and delta 9 desaturation. Daily administration of insulin for 10 days restored and overcorrected the various lipid alterations. This study suggests that there are alterations in lipid composition and metabolism in the exocrine pancreas of chronic streptozotocin-induced diabetic rats. Their possible role in the mechanism regulating pancreatic function and secretion remains to be elucidated.

Animals↗
PubMed1988

Steatorrhea and disorders of chylomicron synthesis and secretion.

Knowledge concerning the absorptive phase of fat remains relatively scanty as compared to the wealth of information available on the digestive phase. However, the past years have seen important developments in our understanding of chylomicron formation and secretion. This has come about thanks to clinical studies of rare congenital disorders of chylomicron synthesis and exocytosis and to the creation of experimental models.

Celiac Disease↗
PubMed1988

Digestive and absorptive phase anomalies associated with the exocrine pancreatic insufficiency of cystic fibrosis.

The pancreas has an enormous reserve capacity, and significant malabsorption usually signals complete absence of exocrine function. However, there is evidence that acid lipases of nonpancreatic origin play an important compensatory role. Complete duodenal hydrolysis of fat requires a series of complex interdependent physicochemical events involving pancreatic lipase, colipase, phospholipase A2, and bile salts in an environment where the pH must be close to neutrality. Lipolytic products must then be shuttled through the unstirred water layer to the surface of the microvillus membrane by ionized bile salts, which must be present in sufficient concentrations to form micelles. In pancreatic insufficiency, there is not only a defective lipolytic phase but also an impaired micellar phase. The output of bile salts is decreased because of increased fecal loss. Furthermore, a significant percentage of bile salts precipitate because the duodenum is acidic and there is a large predominance of glycine conjugates. Although much less work has been done on the absorptive phase of patients with pancreatic insufficiency, there is tentative evidence that defective phospholipid absorption, essential fatty acid deficiency, and protein malnutrition could impair the absorptive phase, particularly chylomicron formation. Although significant advances have been made in our understanding of factors responsible for malabsorption associated with pancreatic insufficiency, much remains to be done for the further delineation of defects. It is hoped that this will lead to further refinements of enzyme preparations and to new strategies of intervention.

Cystic Fibrosis↗
PubMed1988

Immunocytochemical and biochemical evaluation of pancreatic lipase in acinar cells of control and streptozotocin-induced diabetic rats.

Pancreatic lipase was revealed by immunocytochemistry and analyzed biochemically in pancreatic tissue from control, diabetic, and insulin-treated diabetic rats. In the three groups of animals, lipase antigenic sites were detected with high resolution in the acinar cells in the compartments involved in protein secretion: rough endoplasmic reticulum, Golgi apparatus, and secretory zymogen granules. The quantitative evaluation of the intensities of labeling has demonstrated that, in contrast to other pancreatic proteins, lipase is concentrated only at the transition between the Golgi apparatus and the condensing vacuoles. This indicates that, although sharing the same secretory pathway as amylase and chymotrypsinogen, lipase may in fact be processed differently. On the other hand, when compared with controls, lipase immunolabelings in tissues with diabetic condition were higher in all the cellular compartments. Treatment of diabetic animals with insulin was found to restore these levels to those obtained in control condition. The biochemical determination of lipase activities in pancreatic tissues confirmed the immunocytochemical data. These results, together with those obtained previously for amylase and chymotrypsinogen, indicate that in diabetic condition secretion from the acinar cells is significantly altered, which may influence intestinal digestion and absorption processes. These modifications, and the enhancement of lipase in particular, could play a role in the pathogenesis of the hyperlipidemic condition present in diabetes.

Animals↗
PubMed1988

A computer-based program for the follow-up of prostatic cancer patients.

A computer-based record program for the follow-up of prostatic cancer patients is described and its practical applications discussed. The system enables the user to record personal data, medical history follow-up (including laboratory and imaging tests), treatment and the response to it. The program can generate reports as a summary letter to the referring physician, follow-up notes on a specific date, laboratory test results on a chronological base, etc. It has the capability to analyse statistically the medical database accumulated with the aid of SPSS (Statistical Package for Social Sciences). The program, which is designed for a micro-computer, is conducted on the IBM Personal Computer. By providing instant access to all comprehensive information, the system is a valuable tool for the correct staging of disease and for systematic follow-up; most of all, it is a "real-time instrument" for the analysis of medical results.

Follow-Up Studies↗
PubMed1988

Assessing the value of employee training.

Scarce economic resources make cost-benefit assessment of employee training programs an important issue. It is helpful to review the role evaluation plays in training and apply cost-benefit assessment to management development programming.

Cost-Benefit Analysis↗
PubMed1988

Circulating lipids and lipoproteins in glycogen storage disease type I with nocturnal intragastric feeding.

With the advent of nocturnal intragastric feeding which protects against acute metabolic complications and promotes growth, patients with glycogen storage disease type I are attracting less attention. However, several biochemical alterations persist and suggest that the long-term risk of atherosclerotic heart disease remains high. Persisting hypertriglyceridemia and hypercholesterolemia were found in seven glycogen storage disease type I subjects, six of them following 5-6 yr of nocturnal intragastric feeding. When compared to ten age-matched controls, the patients showed significantly (P less than 0.001) higher low density lipoprotein cholesterol (LDL-C) (247.7 +/- 46.8 vs. 115.3 +/- 5.0 mg/dl) and lower high density lipoprotein cholesterol (HDL-C) (26.4 +/- 3.4 vs. 55.8 +/- 2.9 mg/dl). Triglyceride (TG) enrichment with cholesteryl ester depletion characterized the lipoprotein classes. The diameters of very low density lipoproteins (VLDL) and LDL were larger, while that of HDL was smaller and consistent with the predominance of the HDL3 subclass and a lower apoA-I/apoA-II ratio. The raised levels of TG appeared attributable not only to the well-described lipogenesis, but also to impaired catabolism of fat, as evidenced by the significantly (P less than 0.001) decreased activity of both peripheral lipoprotein lipase (3.17 +/- 0.43 vs. 14.15 +/- 0.50 mumol FFA.ml-1.hr-1) and hepatic lipase (1.88 +/- 0.30 vs. 4.83 +/- 0.90). This may well explain the high concentration of intermediate density lipoprotein (IDL) and the impaired conversion of HDL3 to HDL2. Low apoC-II/apoC-III1 could be related to defective lipoprotein lipase activity. These data suggest that glycogen storage disease type I patients on nocturnal intragastric feeding remain at risk for atherosclerosis and its complications.

Adolescent↗
PubMed1988

Decrease of urine creatinine in vitro in spinal cord injury patients.

Freshly voided urine from 3 spinal cord injury (SCI) patients showed a progressive decline in creatinine concentration over 2 weeks while maintained in the refrigerator. Urine creatinine concentration remained stable in normals, patients with kidney disease and 9 other SCI patients. Mixtures of affected and normal urine showed a progressive decline in creatinine. Boiling or filtering prevented the decline while light centrifugation enhanced the decrease in the sediment but minimized it in the supernatant. Streptococcus fecalis was cultured from all 3 patients' urine, and produced a dramatic fall in creatinine concentration on incubation in broth with creatinine, as well as when added to normal urine. In the refrigerator, however, S. fecalis added to broth with creatinine, as well as to urine did not produce significant fall in creatinine concentration. Thus in certain SCI patients creatinine concentration decreases even when freshly obtained urine is maintained in the refrigerator. The cause of the fall in creatinine may relate to the presence of S. fecalis.

Creatinine↗
PubMed1988

The immunologic profile of anesthetists.

Reports in the literature have suggested possible impairment of immunocompetence in operating theater personnel. In a group of 18 physician anesthesiologists the following were determined: hemoglobin concentration; white blood cell count; numbers of T, B, and natural killer (NK) lymphocytes; number of T-active cells; and numbers of T-helper/inducer (Th) and T-suppressor/cytotoxic (Ts) cells; and the Th/Ts ratio. Function of T lymphocytes was evaluated using the local xenogeneic graft-versus-host reaction and spontaneous suppressor or helper activity of T cells. The same parameters were determined in a group of 18 age- and sex-matched healthy controls. It was found that no matter what their age or how long they have been engaged in anesthetic practice, anesthetists show no immunosuppression as evidenced by these parameters.

Adult↗
PubMed1987

Structure and evolutionary origin of the gene encoding mouse NF-M, the middle-molecular-mass neurofilament protein.

We describe the complete sequence of the gene encoding mouse NF-M, the middle-molecular-mass neurofilament protein. The coding sequence is interrupted by two intervening sequences which align perfectly with the first two intervening sequences in the gene encoding NF-L (the low-molecular-mass neurofilament protein); there is no intron in the gene encoding NF-M corresponding to the third intron in NF-L. Therefore, both the number of introns and their arrangement in the genes coding NF-L and NF-M contrast sharply with the number and arrangement of introns in the genes of known sequence, encoding other members of the intermediate filament multigene family (desmin, vimentin, glial fibrillary acidic protein and the acidic and basic keratins); with the exception of a single truncated keratin gene that lacks an encoded tailpiece, these genes all contain eight introns, of which at least six are placed at homologous locations. Assuming the existence of a primordial intermediate filament gene containing most (if not all) the introns found in contemporary non-neurofilament intermediate filament genes, it seems likely that an RNA-mediated transposition event was involved in the generation of an ancestral gene encoding the NF polypeptides. A combination of insertional transposition and gene-duplication events could then explain the anomalous number and placement of introns within these genes. Consistent with this notion, we show that the genes encoding NF-M and NF-L are linked.

Amino Acid Sequence↗
PubMed1987

Plasma and lipoprotein fatty acid composition in glycogen storage disease type I.

Nocturnal intragastric feeding has been shown to be an effective means to improve clinical and biochemical features in glycogen storage disease type I (GSD-I). In this study, we investigated the fatty acid patterns in a whole plasma and in circulating lipoproteins in patients on this therapy. The results demonstrated massive concentration of total fatty acids coupled with higher levels of triglycerides, free cholesterol, cholesterol ester and phospholipids. This hyperlipidemia involved all fatty acids without distinction of carbon or bond numbers. However, the increase was more pronounced for saturated than polyunsaturated fatty acids, as was demonstrated by the ratios of both oleic acid to linoleic acid (1.91 +/- 0.40 vs 0.80 +/- 0.09 in controls) and of omega 3 + omega 6 to omega 9 fatty acid families (0.92 +/- 0.11 vs 1.66 +/- 0.08 in controls). The fatty acid patterns in very low (VLDL), low (LDL) and high (HDL) density lipoprotein showed substantial differences in composition, reflecting an association between an abnormal lipoprotein pattern and essential fatty acid deficiency. Furthermore, GSD-I patients exhibited a significant increase in VLDL (17 +/- 2 vs 47 +/- 7 mg/dl) and LDL cholesterol (124 +/- 7 vs 206 +/- 24 mg/dl), coupled with a decrease in HDL cholesterol (49 +/- 4 vs 28 +/- 3 mg/dl). These data documenting high LDL cholesterol and low HDL cholesterol associated with an increased concentration and proportion of saturated fatty acids suggest that GSD-I patients on nocturnal intragastric feeding are at high risk for atherosclerosis and its complications.

Adolescent↗