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Biomedical subjects

I Levy

Publications and source records attributed to I Levy.

At least 19 recordsLinked to original sources
PubMed2000

Elevated cytosolic phospholipase A(2) expression and activity in human neutrophils during sepsis.

Sepsis is defined as the systemic inflammatory response to infection. Phospholipase A(2) (PLA(2)) plays an important role in inflammation processes by initiating the production of inflammatory mediators. The role of cytosolic PLA (cPLA(2)) has not yet been identified in inflammatory and infectious disease clinical settings. The aim of the present research was to determine whether cPLA(2) activity has a role during sepsis. Since neutrophil activation has been documented during sepsis, these cells were chosen as a model to evaluate the function of cPLA(2) in this clinical setting. cPLA(2 )was studied at 3 levels: activity, protein expression, and messenger RNA (mRNA). Neutrophils from 32 septic patients with and without bacteremia were examined. cPLA(2) activity was measured using labeled phosphatidyl choline vesicles as a substrate, and total PLA(2) was determined by the release of labeled arachidonic acid from prelabeled cells. A significant increase in cPLA(2) activity, protein expression, and total PLA(2) activity in neutrophils was detected during sepsis. mRNA levels, detected by reverse transcriptase-polymerase chain reaction, were significantly higher during sepsis, indicating that the increase in the amount of cPLA(2) is regulated on the mRNA level. The significant elevation of cPLA(2) activity and expression in neutrophils during sepsis suggests that this enzyme plays a major role in neutrophil function in this clinical setting. (Blood. 2000;95:660-665)

Adult↗
PubMed1999

Complete recovery after spontaneous drainage of pancreatic abscess into the stomach.

Pancreatic abscess is a dreaded complication of acute pancreatitis, with a high death rate even with aggressive surgical treatment. We report two cases in which recovery followed spontaneous drainage into the stomach. A 75-year-old woman with biliary pancreatitis and a 63-year-old man with ethanol-induced pancreatitis both developed pancreatic abscess, diagnosed by computed tomography scans and ultrasound. The spontaneous gastric fistula was heralded by a large emesis of purulent and necrotic material in one case and copious nasogastric tube secretions of a similar material in the other. Defervescence was immediate, and both patients went on to complete recovery without any further interventions. Contrast studies showed the fistulae. It is concluded that in the event that a pancreatic pseudocyst spontaneously drains into the stomach a 'wait and see' policy should be adopted, and a favorable outcome can be expected.

Abscess↗
PubMed1999

Decreased CGRP, but preserved Trk A immunoreactivity in nerve fibres in inflamed human superficial temporal arteries.

The peptidergic sensory innervation of cranial blood vessels may play an important part in vascular head pain. The neuropeptides calcitonin gene-related peptide (CGRP) and substance P in sensory fibres are dependent on nerve growth factor (NGF) produced by the blood vessels, and when released from nerve terminals mediate neurogenic inflammation. NGF is increased in inflamed tissues, and acts via its high affinity receptor trk A on nociceptor fibres to produce hyperalgesia. CGRP and trk A immunoreactive nerve fibres have therefore been studied, for the first time, in inflamed (n=7) and non-inflamed (n=10) temporal arteries biopsied from patients with headache and suspected giant cell arteritis. CGRP immunoreactivity was markedly decreased to absent in adventitial nerve fibres in inflamed regions of vessels, which may reflect secretion from nerve terminals, as CGRP immunoreactivity could still be seen in nerve trunks in periadventitial tissue. Trk A immunoreactive nerve fibres were found in a similar distribution to CGRP containing nerve fibres in non-inflamed vessels, and the trk A immunoreactivity was virtually unchanged in inflamed vessels. The evidence supports a role for NGF related mechanisms in inflammatory vascular head pain. Anti-NGF or anti-trk A agents may represent novel analgesics in this condition.

Adult↗
PubMed1999

Usefulness of ambulatory blood pressure monitoring in pregnant women with type 1 diabetes.

OBJECTIVE: Pregnancy in type 1 diabetes is associated with an increased risk of developing pregnancy-induced hypertension (PIH). Ambulatory blood pressure monitoring (ABPM) has been used to screen for preeclampsia in nondiabetic pregnancy. To date, there are no data regarding ABPM during pregnancy in normotensive type 1 diabetic women. This study sought to establish blood pressure (BP) profiles for pregnant type 1 diabetic women using ABPM and determine whether the BP pattern can define a population at risk for developing PIH. RESEARCH DESIGN AND METHODS: ABPM was carried out for one 24-h period during each trimester--in the first trimester between weeks 7 and 12, in the second trimester between weeks 20 and 24, and in the third trimester between weeks 30 and 34--in 22 normotensive pregnant type 1 diabetic and 10 pregnant nondiabetic women. RESULTS: The incidence of PIH was fourfold greater in type 1 diabetic women than in control subjects. Diabetic women showed higher daily diastolic BP in the third trimester compared with nondiabetic pregnant women. Diabetic women who developed PIH in the third trimester showed significantly higher BP profiles throughout gestation than those who remained normotensive. Receiver operator characteristics curves for nighttime systolic BP showed the best predictive capacity for PIH, with a cutoff > 105 mmHg (85% sensitivity and 92% specificity). CONCLUSIONS: Our study confirms the early increase of BP in patients who will develop PIH and suggests that nighttime systolic BP >105 mmHg in the second trimester is a useful predictor of PIH. ABPM may be useful in screening for PIH in pregnant diabetic women.

Adolescent↗
PubMed1999

[Non-specific cecal ulcer in a patient with chronic renal failure in hemodialysis treatment. Case report].

We report a 65 years old female undergoing hemodialysis, presenting with intense pain in the lower right quadrant and moderate hematochezia. Since symptoms did not abate after an appendectomy, a colonoscopy and barium enema were performed, whose results suggested an advanced cecal carcinoma. Biopsies were negative for cancer. A new surgical abdominal exploration disclosed a cecal inflammatory and transmural lesion. A right colectomy was performed and the patient had a satisfactory postoperative evolution. Pathological study of the surgical piece showed a six cm perforated profound ulceration and a two cm ulcer. Both had precise limits. Unspecific cecal ulcers are rare entities that must be born in mind in the differential diagnosis of abdominal pain or hematochezia, specially in patients undergoing chronic hemodialysis.

Cecal Diseases↗
PubMed1998

[Effects of vertical banded gastroplasty on weight, quality of life and nutrition].

We examined the long term results of vertical banded gastroplasty 3-10 years after operation. They were assessed by weight lost, incidence and severity of untoward effects and improvement in diet and in quality of life in 75 of 122 who had had the operation. Average weight lost was 28.5 +/- 14.9 kg (p < 0.001) in 5 years and 58.6 +/- 30.4% of excess weight, which brought patients to within 32 +/- 25.2% of ideal weight. According to these measures, in 63-76% the operation had been successful in causing weight loss. The 2 criteria for successful weight loss were loss of more than 50% of weight in excess of ideal body weight and residual body weight less than 50% greater than ideal body weight. There was a greater risk of failure in unmarried subjects older than 45 (odds ratio for not losing weight was 6; in those weighing more than 120 kg it was 9). We saw evidence of this mostly 4 years after operation (odds ratio 11). The degree of success in weight loss was correlated with texture of food (softness) preferred and length of operation. Of those interviewed, only 65% were satisfied with their results. The greatest improvement in quality of life measurements was in physical activity, perception of health, and frequency of feeling depressed. Side-effects were vomiting, reflux and fatigue. Only 34.7% were able to digest solid foods, so that subjects are at risk for nutritional deficiencies.

Adult↗
PubMed1998

Emergence of Candida parapsilosis as the predominant species causing candidemia in children.

An increase in the rate of isolation of Candida parapsilosis, relative to other Candida species, in our children's hospital led us to analyze the clinical and epidemiological variables associated with candidemia. We sought to determine if these variables are different for patients infected with C. parapsilosis. All episodes of candidemia occurring over a 7-year period were analyzed retrospectively. Of 81 episodes in 80 patients, 35 (43%) were in neonates, and 46 (57%) were in nonneonates. C. parapsilosis was isolated in 40 episodes (49%). C. parapsilosis was significantly more likely than non-C. parapsilosis species to be associated with prematurity (P = .001), presence of a central venous catheter (P = .002), and use of total parenteral nutrition (P = .03). C. parapsilosis has emerged as the predominant species in our children's hospital. The mortality rate associated with candidemia in children is lower than previously reported and may be associated with the high rate of isolation of C. parapsilosis.

Adolescent↗
PubMed1998

Medical, cognitive, emotional, and behavioral outcomes in school-age children conceived by in-vitro fertilization.

Assessed long-term effects of assisted reproduction technologies of in-vitro fertilization (IVF) and related techniques of embryo transfer (ET) on children's adjustment. 51 school-age Israeli children conceived by IVF/ET were compared with 51 control-matched children conceived spontaneously. The assessment included a comprehensive medical evaluation, a psychological examination, teachers' reports, parents' reports, and children's self-reports. As compared with controls, IVF/ET children did not reveal significant differences in physical and neurological status or on cognitive measures of IQ, visual-motor coordination, visual memory, and verbal comprehension. Nevertheless, the IVF/ET children were scored lower by teachers on measures of socioemotional adjustment in school and on self-report measures of anxiety, aggression, and depression. Among IVF/ET children, the tendency to be at a greater risk for emotional disturbances was exacerbated among boys and among children whose parents were older.

Affective Symptoms↗
PubMed1998

Monograph series on aging-related diseases: X. Prostate cancer.

Prostate cancer is the most commonly diagnosed cancer among Canadian men, excluding non-melanoma skin cancer. Prostate cancer incidence increases almost exponentially with age; most cases are diagnosed in men aged 65 years or older. With the possible exception of animal fat consumption, no known widespread modifiable risk factors have been identified. Although the prognosis is good if appropriate treatment occurs in the early stages of disease, the ability of existing early detection techniques to decrease mortality has not yet been demonstrated. The considerable economic and societal burden of prostate cancer and its treatment, coupled with the projected large increase in the number of new prostate cancer cases as the population ages, make this disease a very important public health issue.

Aged↗
PubMed1997

Low mitochondrial glycerophosphate dehydrogenase activity in lymphocytes of women with gestational diabetes.

An abnormally low activity of mitochondrial FAD-linked glycerophosphate dehydrogenase (m-GDH), relative to the paired measurement of glutamate dehydrogenase, was found in CD3+ lymphocytes from 4 out of 14 mothers with gestational diabetes mellitus, but in none of 36 control mothers. The low m-GDH activity coincided with an abnormally high incidence of familial history for non-insulin-dependent diabetes. These findings are compatible with the view that an inherited or acquired defect of m-GDH may participate to the pathogenesis of beta-cell dysfunction in a subgroup of patients with gestational diabetes.

Adult↗
PubMed1997

Infected hydrocele following laparoscopic appendectomy: case report.

In the literature, specific reported complications after laparoscopic appendectomy include bowel injury, hemorrhage, wound infection, and cecal fistula. We report the occurrence of infected hydrocele after laparoscopic appendectomy in a 20-year-old man. This complication, to our knowledge, has not yet been described in the literature.

Adult↗
PubMed1997

Development of an instrument to measure cancer screening knowledge, attitudes and behaviours.

The development of a comprehensive survey instrument to measure the knowledge, attitudes and behaviours of the general public with regard to cancer screening was the goal of this project. A thorough review of the literature was undertaken, and existing survey instruments were identified and organized according to type of cancer screening behaviour being measured; question foci (predisposing, enabling and reinforcing factors); and survey implementation protocol. A comprehensive survey instrument was developed with the intention that, if feasible, the survey of cancer screening behaviours could be implemented nationally by telephone. Separate survey instruments were developed according to sex. Focus groups were held across Canada to determine the comprehensiveness of the survey items; ease of understanding and ability to respond; feasibility with respect to possible sensitivity of some of the question items; and general implementation issues (e.g. length, sex of interviewer). This paper reports on the qualitative portion of the project. Our study supports the use of qualitative methodology for instrument development and implementation.

Canada↗
PubMed1996

[Presence of markers predictive of type I pre-diabetes mellitus status in relatives of patients with type I diabetes mellitus].

BACKGROUND: The aim of this study was to analyze the predictive factors of IDDM in first degree relatives of IDDM patients. SUBJECTS AND METHODS: From 1992 to 1994, 1,053 first degree relatives were screened for measuring islet cell antibodies (ICA) by indirect immunofluorescence (iFl). In all ICA positive subjects, beta cell function was analyzed by intravenous glucose tolerance test (IVGTT) and other immunologic parameters were also studied: anti-insulin antibodies (IAA) by radiobinding and antibodies to glutamic acid decarboxylase (GADAb) by ELISA methods. RESULTS: ICA were found in 3.1% of the first degree relatives. IVGTT showed a significant decrease in acute first phase of insulin response to glucose (IRI 1 minute + 3 minute) in those with ICA > or = 20 JDF units. In patients with ICA > or = 20 JDF units, 20% were found to be positive for IAA and 40% were positive for GAdAb. Thirty-one percent (10/32) of ICA positive first degree relatives fulfilled prediabetes criteria. During follow-up, 40% (4/10) of these prediabetic patients developed IDDM. CONCLUSION: This study confirms the possibility of identifying among first degree relatives of IDDM patients the subgroup with high risk of developing IDDM thus allowing the initiation of therapy for preventing or delaying IDDM onset.

Adolescent↗
PubMed1996

A prospective study of Gram-negative bacteremia in children.

BACKGROUND: Hospital- and community-acquired Gram-negative bacteremia is a significant cause of mortality and morbidity in pediatric medical centers. Gram-negative organisms are isolated in > 50% of pediatric patients with bacteremia. OBJECTIVES: To analyze clinical and epidemiologic variables associated with Gram-negative bacteremia in a tertiary children's medical center. METHODS: A 6-year prospective study of children with Gram-negative bacteremia in a tertiary care children's medical center in Israel. RESULTS: Three hundred seventy-four episodes of Gram-negative bacteremia were studied during 6 years. The predominant isolates were Klebsiella pneumoniae, Pseudomonas aeruginosa and Escherichia coli, which accounted for 109, 81 and 79 episodes (26, 20 and 19%), respectively. Of all episodes 43% occurred in neonates and infants younger than 2 years and 47% were hospital-acquired. Underlying conditions mainly acute leukemia and lymphoma, were present in 55% of the patients. Urinary tract infection followed by lower respiratory tract infection were the most common identified sources of bacteremia. Central intravenous catheters were associated with 53% of the episodes. The crude mortality was 11.4%. Increased mortality was significantly associated with acute leukemia, neutropenia, hospital-acquired infections and previous corticosteroid therapy (P = 0.03, 0.003, 0.006 and 0.01, respectively). Increased antibiotic resistance of hospital-acquired vs community-acquired isolates was noted; 44 to 77% resistance of nosocomial Klebsiella and Enterobacter sp. to second and third generation cephalosporins and 18% were resistant to amikacin. CONCLUSIONS: Klebsiella pneumoniae is currently the most common organism causing Gram-negative bacteremia in children. Because of the relatively high resistance of Gram-negative organisms to second and third generation cephalosporins, we suggest that empiric antibiotic therapy for Gram-negative bacteremia include a combination of an aminoglycoside and an anti-Pseudomonas beta-lactam.

Adolescent↗
PubMed1996

Peripheral intravenous infusion--another cause of air embolism.

We report an unusual complication of intravenous infusion. A 4-week-old baby developed acute cardiopulmonary distress because of air embolism caused by improper preparation of peripheral intravenous set. The estimated amount of infused air was 12 ml (approximately 3.5 ml/kg). The infant recovered promptly after short supportive treatment.

Embolism, Air↗