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Biomedical subjects

G M Levine

Publications and source records attributed to G M Levine.

At least 19 recordsLinked to original sources
PubMed2001

Intravenous metronidazole for the treatment of Clostridium difficile colitis.

PURPOSE: Severe Clostridium difficile colitis may produce abdominal distention and ileus, precluding oral antibiotic therapy. Stimulated by several case reports in which intravenous metronidazole was used, we reviewed our experience. METHODS: Using pharmacy and microbiology laboratory records, we retrospectively identified patients with C. difficile colitis who received intravenous metronidazole as initial monotherapy. To be included, patients had to fulfill the following criteria: 1) at least six doses (equivalent to two days of therapy) of intravenous metronidazole were administered, 2) no other potential cause for colitis was found, and 3) the diagnosis of C. difficile colitis was firmly established. For eligible patients, five clinical parameters were assessed before and after intravenous metronidazole. RESULTS: Our patient group (n = 10) received an average of 13.7 (range, 6-24) doses of intravenous metronidazole as initial therapy for C. difficile colitis. All received a dose of 500 mg three times daily. The majority of patients with vomiting, fever, and/or abdominal pain present at the beginning of therapy had resolution with intravenous metronidazole. Only one patient developed a symptom (vomiting) while on therapy; however, this eventually resolved when oral metronidazole was instituted. No patient required colectomy for refractory colitis or developed toxic megacolon. No patient, including those on prolonged courses, developed toxicity related to intravenous metronidazole such as peripheral neuropathy. CONCLUSIONS: Intravenous metronidazole may be effective therapy in patients with C. difficile colitis. A randomized, prospective study appears warranted.

Adult↗
PubMed2001

How gastroenterologists inform patients of results after lower endoscopy.

OBJECTIVE: Little is known about how gastroenterologists communicate endoscopic findings and biopsy results to their patients. We sought to determine the factors that may influence this behavior. METHODS: A survey questionnaire was developed and mailed to the 80 members of the Delaware Valley Society for GI Endoscopy. Information was obtained on the demographic characteristics and responses to six case vignettes prepared to examine communication patterns. We determined possible influences of conscious sedation and the benignity or severity of findings on communication practices. RESULTS: Sixty-one surveys (76%) were completed and analyzed. Endoscopists immediately inform patients of normal results. For abnormal results, 92% would immediately inform nonsedated patients versus 79% that would inform sedated patients (p < 0.008). Analysis of responses to the case vignettes indicated that 82% of endoscopists would immediately reassure the patient about a benign appearing (< 1 cm) polyp, but only 70% would do so for a polyp > 2 cm (p < 0.01). In contrast, when presented with a frank malignancy, 94% would inform the patient. Eighty-four percent of endoscopists would telephone results of a benign pathology report, but only 34% would telephone report a dysplastic lesion (p < 0.001). There was no correlation between the response rate and various demographic parameters such as physician age, type of, or length of time in practice. CONCLUSIONS: Gastroenterologists usually report normal findings immediately, but are less likely to do so after use of sedation or encountering abnormal findings. Most of those surveyed would use the telephone to communicate abnormal findings.

Adult↗
PubMed1994

Phase I clinical evaluation of a new murine monoclonal antibody (Mu-9) against colon-specific antigen-p for targeting gastrointestinal carcinomas.

BACKGROUND: Colon-specific antigen-p is a tumor-associated antigen present in approximately 60% of colorectal cancers. Preclinical studies have shown that the murine monoclonal antibody Mu-9 has excellent tumor-targeting abilities; therefore, clinical studies were initiated. METHODS: The immunoglobulin G and F(ab')2 were radiolabeled with 131I and administered to 13 and 12 patients, respectively, with advanced gastrointestinal cancer (colon, rectal, and pancreatic) for radioimmunodetection or radioimmunotherapy. RESULTS: Even in patients with highly elevated carcinoembryonic antigen levels, only one patient showed appreciable complexation of the labeled antibody, suggesting the epitope may not be highly expressed in the blood. Fifty percent of 131I-Mu-9 immunoglobulin G was cleared from the blood within 41 +/- 13 hours, while it took only 19 +/- 8 hours for the same amount of 131I-F(ab')2 to be cleared from the blood. Lesion detection in the abdomen, liver, and pelvis was greater than 90% for either the immunoglobulin G or F(ab')2. The dose absorbed by the normal organs, except the kidneys, was two- to threefold less for the F(ab')2 than for the whole immunoglobulin G. The dose to the kidneys was similar for both forms of immunoglobulin. The average tumor dose for 131I-Mu-9 immunoglobulin G was 13.9 +/- 11.0 cGy/mCi, and for 131I-F(ab')2 was 4.9 +/- 2.9. Tumor/red marrow dose ratios for the whole immunoglobulin G were 4.3 +/- 3.0, compared to 3.3 +/- 1.9 for the F(ab')2, suggesting the therapeutic window for the two forms of immunoglobulin may be similar. Eight of nine patients given the whole immunoglobulin G developed highly elevated levels of human anti-mouse antibody, whereas lower values were observed in five of seven patients given the F(ab')2. CONCLUSIONS: These initial results support the need for further evaluation of Mu-9 immunoglobulin G and F(ab')2 for targeting gastrointestinal cancer for radioimmunotherapy.

Adult↗
PubMed1994

Immunoscintigraphy of Pneumocystis carinii pneumonia in AIDS patients.

UNLABELLED: The diagnosis of Pneumocystis carinii pneumonia (PCP) currently relies upon cytological demonstration of the organism in sputum or bronchoscopy specimens. The purpose of this study was to develop a radiolabeled monoclonal antibody (Mab) against Pneumocystis carinii (P. carinii) and to evaluate its use for imaging PCP. METHODS: We studied 16 HIV-infected patients with pneumonia in order to evaluate a new Mab-based imaging method for diagnosing PCP. Most patients were managed for opportunistic pneumonia associated with AIDS, including standard cytological tests, and, in all cases, intensive chemotherapy. Prior to the clinical study, the Mab raised to P. carinii was shown to react with human P. carinii but not with rat P. carinii or human white blood cells. RESULTS: After labeling a 1-mg Mab Fab' fragment with 30 mCi of 99mTc, the presence or absence of PCP could be confirmed in six of seven or seven of eight assessable patients, respectively, by external photoscanning within 24 hr. This shows a sensitivity of 85.7% and a specificity of 86.7%. CONCLUSION: Our findings suggest that PCP can be diagnosed by a noninvasive imaging method employing a small dose of a 99mTc-labeled Mab showing specificity for the infectious organism, since patients with P. carinii-free pneumonia were correctly negative in 87.5% of cases. Rapid diagnosis and organ-localization of other infectious lesions with organism-specific, radiolabeled Mabs may be feasible.

AIDS-Related Opportunistic Infections↗
PubMed1992

Impact of a quality assurance program on gastrointestinal endoscopy.

The impact of a quality assurance committee on documentation and use of gastrointestinal endoscopy was assessed. The committee, fulfilling Joint Commission on Accreditation of Healthcare Organizations criteria, performed retrospective (1984-1985) and prospective (1986-1988) reviews of all endoscopies. Criteria were developed from American College of Physicians and American Society for Gastrointestinal Endoscopy guidelines. All reviews of procedures that were questioned were returned to physicians for clarification. After reconsideration of the response, procedures were judged either justified or unjustified. There has been significant improvement in the quality of endoscopy reporting and documentation. The rate of questioned procedures decreased from 21.6% (95% confidence interval (CI), 20.1-23.1) in 1984-1985 to 9.2% (95% CI, 7.9-10.4) (P less than 0.01) in 1988. Improvement in use was reflected in the significant decrease in the rate of unjustified procedures from 8.2% (95% CI, 7.2-9.2) in 1984-1985 to 1.5% (95% CI, 1.0-2.0) (P less than 0.01) in 1988. Most importantly, this process curtailed the previously noted 10% annual increase in the number of endoscopic procedures (P less than 0.01).

Endoscopy, Gastrointestinal↗
PubMed1992

Nutrition support team recommendations can reduce hospital costs.

Providing nutrition support may be costly to hospitals under the prospective payment system. A nutrition support team, however, can be effective in controlling costs. To demonstrate the importance of the nutrition support team and to quantify the potential cost savings that can be achieved, a retrospective review of the effect of our team on hospital costs was conducted for the 12-month period of October 1989 to September 1990. The team supervises but does not regulate the use of total parenteral nutrition (TPN). During this time period, 176 patients received TPN. In 14 patients, the use of TPN was inappropriate, representing $65,349 in excess costs. After the cost of providing enteral nutrition to these patients (estimated at $2,430) was deducted, a net loss of $62,919 occurred. Nutrition support team action saved an additional $45,186 in hospital charges when recommendations to discontinue TPN were eventually heeded. Nutrition support team approval before TPN is initiated would achieve cost savings.

Academic Medical Centers↗
PubMed1990

Nuclear medicine studies of aging: X. Relationship of liver and spleen lengths at age 65 years and older.

For 3 groups of patients aged 65 years or greater, liver and spleen lengths were measured from calibrated radiocolloid images. Length relationships between liver (L) and spleen (S) were examined in terms of S as a function of L, as well as (S/L) and (L-S) vs S or L. Liver and spleen lengths were the least well correlated in these patients. The S/L ratio vs S produced the most significant correlation in all 3 groups. This suggests a complex but describable relationship between liver and spleen lengths in the overall aging population, and provides a baseline for comparing the effects of various diseases on S and L.

Aged↗
PubMed1989

Comparison of different caloric substrates on intestinal adaptation in the rat.

We compared the relative efficacy of medium- and long-chain triglycerides and dextrose on intestinal adaptation. Parenterally nourished rats received an isocaloric luminal infusion of one of these three substrates for 1 wk into either the jejunum or the ileum. Intestinal mass (mucosal weight and protein content) as well as the in vivo absorption of 5 mM glucose, valine, and aspartic acid were measured. In the jejunum, long-chain triglycerides were the most trophic, whereas in the ileum, long-chain triglycerides and dextrose were equally effective, but significantly more trophic than medium-chain triglycerides. In general, absorptive function was better maintained by dextrose and medium-chain triglycerides than long-chain triglycerides in the jejunum or by dextrose in the ileum. These data demonstrate that the jejunum and ileum respond differently to caloric substrates. Medium-chain triglycerides do not appear to have a clear superiority to long-chain triglycerides or dextrose in producing intestinal adaptation.

Adaptation, Physiological↗
PubMed1989

Gastric pertechnetate contribution to blood pool images.

During a cardiac blood pool study (Tc-99m erythrocytes), there was an apparent "cold" area in the left lobe of the liver. At one hour, the prior void appeared to have filled in, suggesting an intrahepatic hemangioma. However, the changing pattern of radioactivity, and its shape, indicated that this actually represented Tc-99m pertechnetate in the gastric wall and stomach cavity. In a second case, the interval between intravenous injection of stannous pyrophosphate and Tc-99m pertechnetate was prolonged. Changing activity, again in the gastric wall and cavity, obscured part of the liver. This cleared with time, allowing hepatic evaluation. Thus, gastric pertechnetate can contribute to blood pool images of the heart or liver and multiple images may be needed to separate this component from nearby tissues.

Aged↗
PubMed1988

Impact of age, sex, race, and functional complaints on hydrogen (H2) production.

In order to evaluate factors that may influence H2 generation, the effects of age, sex, race, and functional complaints on breath H2 were studied in 62 subjects. These included 34 young hospital employees, 17 healthy ambulatory elderly subjects, and 11 patients with functional bowel disease. The ability to produce H2 was defined by an increase in breath H2 to greater than 20 parts per million within 4 hr of ingesting 10 g of the nonabsorbable sugar lactulose. Overall, 21% of subjects were nonproducers, and the incidence of nonproduction did not vary among the groups. The elderly subjects had significantly greater breath H2 concentrations than the younger subjects at 150 minutes (P less than 0.05). Sex, race, and functional complaints did not influence H2 production. These findings indicate that patient's age and potential inability to make H2 need to be considered in the routine interpretation of H2 breath tests.

Adult↗
PubMed1988

Luminal and metabolic regulation of jejunal amino acid absorption in the rat.

Studies were carried out to determine the role of luminal amino acids and metabolic balance in in vivo amino acid absorption. Previous in vitro studies have shown that adaptation of amino acid transport is a complex phenomenon. In the first series of experiments, parenterally nourished rats received a 7-day jejunal infusion of either 3% aspartic acid, glutamine, lysine, valine, or mixed amino acids. A single-pass perfusion was performed to determine the effects of infusates on 5 mM valine, aspartic acid, and lysine absorption. Compared with controls receiving luminal saline, prior glutamine infusion increased valine absorption; prior valine, glutamine, and aspartic acid infusion significantly increased aspartic acid absorption; and prior valine and lysine infusion significantly increased lysine absorption. The mixed amino acid solution had no effect. The effects of metabolic balance were examined by comparing fasted rats with parenterally fed and orally fed rats. Within 24 h fasting significantly increased valine and aspartic acid absorption, despite a significant decrease in intestinal mass.

Administration, Oral↗