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Biomedical subjects

H Levy

Publications and source records attributed to H Levy.

At least 55 records · Page 3Linked to original sources
PubMed1997

Pleural fluid characteristics in hantavirus pulmonary syndrome.

Hantavirus pulmonary syndrome (HPS), is a rodent-borne, acute, often fulminant cardiorespiratory illness. Noncardiogenic pulmonary edema is prominent in HPS as is cardiac dysfunction. Pleural effusions are commonly noted in patients with HPS and have been thought to be exudative. This report describes the prevalence and characteristics of pleural effusions by an assessment of chest radiographs for the presence of pleural fluid and reviews all pleural fluid specimens obtained from patients with HPS. Of 23 patients treated at the University of New Mexico Hospital for HPS, 22 had evidence of pleural fluid while 4 had sampling of their pleural fluid. Two samples met criteria for an exudate by pleural fluid protein to serum protein ratio of more than 0.5; one was clearly a transudate and the other had inconsistent characteristics. The two exudative samples were obtained 7 days after admission, while the other 2 were obtained within 1 day of admission. Pleural fluid cultures were sterile, and the total of nucleated cells was less than 170/mm3, and predominately mononuclear. A hypothesis may be formulated that the pleural fluid in HPS is initially transudative, consistent with the observed cardiopulmonary dysfunction. However, following aggressive resuscitative efforts and as the acute illness resolves, fluid shifts occur as cardiac function normalizes; the pleural fluid may take on characteristics of an exudate.

Blood Glucose↗
PubMed1996

The International Collaborative Study on maternal phenylketonuria: organization, study design and description of the sample.

The International Maternal Phenylketonuria (PKU) Collaborative Study commenced in 1984 to evaluate the efficacy of the low-phenylalanine diet in reducing the morbidity associated with maternal PKU syndrome. Four hundred and sixty eight (468) pregnancies resulted in 331 live births, 3 stillbirths, 61 spontaneous abortions, 2 ectopic pregnancies and 71 elective terminations. Since its inception, the study has steadily progressed toward its goal of diet initiation preconception or early in pregnancy. By 1994, 51% of the sample began the diet preconceptionally, with an additional 41% doing so by 8 weeks gestation. The number of adolescent pregnancies has decreased from 31% to 9%, college attendance has increased from 5% to 16%, number of women in the lowest socioeconomic classes has decreased from 95% to 59% and average IQ has increased from 78 to 88. The organization of the network of 130 referral centers and clinics within the U.S.A., Canada and Germany and the objectives of the scientific research investigation have served to provide a derived benefit of outreach, education, reproductive counseling and early diet intervention in a large cohort of PKU women.

Adolescent↗
PubMed1996

Outcome implications of the International Maternal Phenylketonuria Collaborative Study (MPKUCS): 1994.

It is well established that women with phenylketonuria who remain untreated during pregnancy face serious problems in offspring outcome. Surveys have documented that maternal phenylalanine (Phe) blood concentrations above 1200 mumol/l are associated with microcephaly, congenital heart disease and intrauterine growth retardation among their offspring. To investigate the efficacy of the Phe restricted diet, the National Institute of Child Health and Human Development in Bethesda Maryland developed an international study to evaluate fetal outcome in pregnancies treated with the Phe restricted diet. The study involves over 100 metabolic clinics in the United States, Canada and Germany, and is now in its 10th year. The results included in this report are still preliminary in nature and the actual risk for such pregnancies remains to be determined.

Diet, Protein-Restricted↗
PubMed1996

Cardiopulmonary manifestations of hantavirus pulmonary syndrome.

OBJECTIVE: To describe the clinical characteristics of a group of patients infected with the newly recognized hantavirus in the Southwestern United States. DESIGN: Case series. SETTING: Tertiary referral center. PATIENTS: All patients with confirmed hantavirus infection admitted to the University of New Mexico Hospital between May 1, 1993 and January 1, 1994. INTERVENTIONS: Records of patients with hantavirus infection were reviewed to collect all pertinent clinical data. MEASUREMENTS AND MAIN RESULTS: Pulmonary disease in these patients was characterized by hypoxemia covering a wide range of severity. The cause of hypoxemia was an increased permeability (noncardiac) pulmonary edema which could be differentiated from hydrostatic (cardiac) pulmonary edema by its association with low pulmonary artery occlusion pressures and increased protein content of edema fluid. Hemodynamic measurements in severe cases showed a shock state characterized by a low cardiac index (range 1.6 to 3.0 L/min/min2), a low stroke volume index (range 10.5 to 29 mL/m2), and high systemic vascular resistance index (range 1,653 to 2,997 dyne.sec/cm5.m2). Progression to death was associated with worsening cardiac dysfunction unresponsive to treatment and causing oxygen debt and lactic acidosis. CONCLUSIONS: The two major life-threatening pathophysiologic changes in Hantavirus Pulmonary Syndrome are increased permeability pulmonary edema, and an atypical form of septic shock caused by myocardial depression and hypovolemia.

Adolescent↗
PubMed1995

Treating early-stage breast cancer: hospital characteristics associated with breast-conserving surgery.

Despite growing acceptance of the fact that women with early-stage breast cancer have similar outcomes with lumpectomy plus radiation as with mastectomy, many studies have revealed the uneven adoption of such breast-conserving surgery. Discharge data from the Hospital Cost and Utilization Project, representing multiple payers, locations, and hospital types, demonstrate increasing trends in breast-conserving surgery as a proportion of breast cancer surgeries from 1981 to 1987. Women with axillary node involvement were less likely to have a lumpectomy, even though consensus recommendations do not preclude this form of treatment when local metastases are present. Non-White race, urban hospital location, and hospital teaching were associated with an increased likelihood of having breast-conserving surgery.

Aged↗
PubMed1995

Adsorption of charged non-albumin bound drugs by amorphous silica.

We investigated the in vitro drug adsorption of PQ 10150 sodium silicate gel (AIS, Santa Clara, CA) with particle size of 230 microns and surface area of 400 m2/g. We observed 99% to 88% adsorption of gentamicin; a mean 91% of disopyramide; a mean 89% of quinidine at low concentration, falling to 75% at higher concentration. Insulin was 88% adsorbed at low concentrations but less so (65%) at higher concentrations. We observed a mean 83% adsorption of procainamide, a mean 84% of N-acetyl procainamide, 74% of lidocaine, 73% of amitriptyline, and 44% of desipramine. We found an average of 14% reduction of total digoxin concentration when serum containing digoxin (2 to 33 ng/mL) was exposed to sodium silicate, while the reduction in free digoxin concentration was 16%. Five percent ethosuximide was also removed. The adsorption of theophylline, phenobarbital, acetaminophen, phenytoin, ethylene glycol, methotrexate, salicylate, thiocyanate and diazepam was minimal and not significant. We conclude that significant amounts of charged, non-albumin bound drugs can be removed by PQ 10150 sodium silicate gel.

Adsorption↗
PubMed1994

Rickettsialpox in a New York City hospital, 1980 to 1989.

BACKGROUND: Rickettsialpox is caused by Rickettsia akari, which is transmitted from rodents to humans by bloodsucking mites. The initial skin lesion forms an eschar and is followed by the development of fever, malaise, myalgia, and 5 to 40 maculopapules and papulovesicles. The disease, which responds to tetracycline, can be mistaken for chickenpox. The diagnosis has been based on an increase in serum antibody titers against R. akari over a period of three to eight weeks. We discuss a more rapid technique that uses direct immunofluorescence to identify R. akari in paraffin-embedded tissue, and we describe the histopathological findings of lesional skin. METHODS: We studied 13 patients (age, 11 months to 58 years) who were seen at Lincoln Hospital in New York City from 1980 to 1989 and were suspected of having rickettsialpox. In nine patients serum samples were obtained during the acute and convalescent phases of the illness for indirect fluorescent-antibody testing. Punch-biopsy specimens of skin lesions were examined by microscopy and by direct fluorescent-antibody testing with an anti-R. rickettsii globulin conjugated with fluorescein isothiocyanate. RESULTS: The diagnosis was confirmed in all 13 patients by indirect or direct fluorescent-antibody techniques. Direct fluorescent-antibody testing of eschars from seven patients was positive in five patients, but negative in two patients who had serologically confirmed rickettsialpox. In contrast, direct fluorescent-antibody testing of papulovesicles from nine patients was positive in only one patient. Histopathological analysis of the eschars revealed extensive necrosis and inflammation. In biopsy specimens of papulovesicles, dermal edema, subepidermal vesicles, and vascular changes were present. CONCLUSIONS: The combination of direct fluorescent-antibody testing of an eschar from the presumed site of inoculation and histopathological examination of papulovesicles for distinctive features represents an improved method of diagnosing rickettsialpox.

Adult↗
PubMed1994

Hantavirus pulmonary syndrome: radiographic findings in 16 patients.

PURPOSE: To characterize chest radiographic features of Hantavirus pulmonary syndrome. MATERIALS AND METHODS: Initial and follow-up chest radiographs from 16 patients with confirmed Hantavirus pulmonary syndrome were reviewed for radiographic findings of either cardiogenic pulmonary edema or pulmonary edema due to increased permeability of the alveolar capillary membranes. RESULTS: Findings indicative of interstitial edema were present more frequently (14 [88%] of 16 patients) than is typically seen in adult respiratory distress syndrome (5%). Alveolar flooding subsequently developed in 11 (69%) of 16 patients and was not the peripheral pattern usually seen in the acute phase of adult respiratory distress syndrome. Overall mortality was 43%. Lung specimens obtained at autopsy showed a pattern of endothelial leak with minimal epithelial injury. CONCLUSION: The lung disease caused by Hantavirus in these patients may explain the findings of interstitial edema and central alveolar filling atypical of adult respiratory distress syndrome. Recognition of the radiographic pattern will be important in identifying this apparently widespread cause of increased permeability pulmonary edema.

Acute Disease↗
PubMed1994

Sputum induction compared with bronchoalveolar lavage by Ballard catheter to diagnose Pneumocystis carinii pneumonia.

Specimens from sputum induction (SI) are often of insufficient volume or have poor diagnostic yield for the diagnosis of Pneumocystis carinii pneumonia (PCP). The Ballard catheter for bronchoalveolar lavage (BAL) is a disposable BAL device which is passed transnasally into the airway and wedged by sensation. Thirty consecutive episodes (21 inpatient and 9 outpatient) in 28 patients positive for HIV (15 with AIDS) were studied with SI and BAL at a tertiary-care university hospital. Six SIs yielded no specimen, and six were judged inadequate for investigation by the laboratory. The BAL return averaged 53 ml (range, 10 to 77 ml), and all specimens were excellent quality based on microscopy. Of the 10 patients (33 percent) who were PCP-positive on BAL, only 2 (6.9 percent) were detected by SI (McNemar p = 0.0078). Of 12 patients in whom SI was unobtainable or inadequate, 6 were positive for PCP on BAL. Two adequate specimens from SI were negative, but BAL specimens were positive for PCP. No patients had specimens that were positive for PCP on SI who had negative BAL specimens. The adequacy of the specimen and the PCP diagnosis with BAL were statistically superior to SI (McNemar p = 0.007). The Ballard BAL catheter allows easy transnasal access to the airway and safe BAL, with a statistically significant superior yield of specimens when compared to SI.

AIDS-Related Opportunistic Infections↗
PubMed1994

Unplanned extubation. Predictors of successful termination of mechanical ventilatory support.

BACKGROUND: Unplanned extubation (self-extubation or accidental extubation) occurs commonly in mechanically ventilated patients, and many patients do not receive mechanical ventilation indefinitely. Unfortunately, weaning parameters are often unavailable in the setting of unplanned extubation, and it would be useful to define pre-extubation respiratory and ventilatory parameters that predict which patients require reintubation. METHODS: The medical records of all patients who experienced unplanned extubation for the 2-year period of July 1989 to July 1991 were reviewed. Pre-extubation values of respiratory rate, tidal volume (VT), fraction of inspired oxygen (FIo2), PEEP, ventilatory mode, and ventilator-delivered minute volume (VVE, ventilator rate multiplied by set VT) were recorded. In addition, the following data were obtained: age, gender, respiratory failure diagnosis, duration of intubation, amount, and type of sedative agents in the 24 h before extubation. Comparisons of these values among patients who ultimately required reintubation and those who were not reintubated were made using the Mann-Whitney U two-sample test. RESULTS: During this period, there were 23 unplanned extubations involving 22 patients. Reintubation was required for 18 episodes of unplanned extubation, but was not required for 5 episodes. There were no significant differences between the two groups for any of the parameters except VVE and FIo2. The mean pre-extubation FIo2 of the reintubated group (0.49) was significantly higher than that of the patients who were not reintubated (0.35) (p = 0.021); all of the patients who remained extubated were receiving an FIo2 < or = 0.40. The VVE was also higher in the reintubated group (9.73 L/min) than in the patients who were not reintubated (1.40 L/min); all patients who remained extubated were receiving < or = 7.0 L/min of ventilator-delivered minute ventilation. CONCLUSIONS: Reintubation after unplanned extubation should not be considered mandatory. Patients who require reintubation have significantly higher preextubation FIo2 and ventilatory requirements than patients who remain extubated.

Female↗
PubMed1994

Comparison of Ballard catheter bronchoalveolar lavage with bronchoscopic bronchoalveolar lavage.

BACKGROUND: Bronchoscopic bronchoalveolar lavage (BAL) in mechanically ventilated patients requires a large endotracheal tube, physician expertise, expensive equipment, and support staff. METHODS: The Ballard BAL catheter is a disposable coude tip 16F device that can be attached to the endotracheal tube and ventilator circuit without loss of positive end-expiratory pressure (PEEP) and also allows supplemental delivery of oxygen between the 12F inner and outer catheters. The catheter is directed into the selected bronchus. The inner catheter with mushroom tip is then advanced until it wedges by feel. Thirteen patients at a tertiary care, university hospital, had BAL performed through both the bronchoscope and Ballard BAL catheter using five aliquots of 20 mL of normal saline solution each. The return was quantified and submitted for blinded, paired laboratory investigations, including Gram stain and quantitative culture, and special stains and cultures as clinically appropriate. RESULTS: The procedure was well tolerated in all patients with no difference between devices in oxygen saturations; however, air leaks occurred in patients undergoing bronchoscopy and compromised safety in one. Two patients required reintubation to facilitate passage of the bronchoscope. The bronchoscopic BAL return averaged 49 mL (range, 5 to 85 mL) while BAL catheter averaged 37 mL (range, 18 to 70 mL) both being sufficient for all desired investigations except one patient who had undergone bronchoscopy. All were of excellent quality based on microscopy. The BAL results were concordant in nine patients: two Pneumocystis carinii, one Candida, one Streptococcus agalactiae, one Streptococcus pneumoniae, and no infection in four. Diagnoses of tuberculosis and Enterococcus (confirmed by blood culture) were obtained by the Ballard BAL catheter only. Kaposi's sarcoma and metastatic histiosarcoma were visualized by bronchoscope only. Two patients had compassionate plea use of the Ballard BAL catheter because of a small endotracheal tube. Hemorrhage secondary to lupus was documented in one and nosocomial infection was excluded in the other. CONCLUSIONS: The Ballard BAL catheter allows easy, safe BAL, without loss of diagnostic yield, when visualization is not required in mechanically ventilated patients. The Ballard BAL catheter allows maintenance of PEEP when used with the supplied adapter and can be used with small endotracheal tubes.

Bacteria↗
PubMed1994

Breast deformity produced by morphea in a young girl.

We report a patient who presented with morphea of the chest wall, and later showed an unusual marked deformity of the breast. We also discuss the differential diagnosis of acquired breast hypoplasia as a complication of a skin disorder.

Breast↗