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Biomedical subjects

J Levine

Publications and source records attributed to J Levine.

374 records · Page 21Linked to original sources
PubMedDate not supplied

Thrombocytopenia in horses: 35 cases (1989-1994).

The records of 3,952 equine patients presenting to the Veterinary Teaching Hospital at North Carolina State University College of Veterinary Medicine were evaluated to determine risk factors associated with thrombocytopenia. Of 2,346 horses from which a CBC was obtained, 35 (1.49%) were thrombocytopenic (platelet count < 75,000/microL). A reference population of 189 horses with normal platelet counts (75,000 to 300,000/microL) was also studied. Standardbred horses were at increased risk for thrombocytopenia, but age and gender were not identified as significant risk factors. Horses with infectious or inflammatory diseases were at increased risk for thrombocytopenia. The potential association of clinical and clinicopathologic factors with thrombocytopenia were assessed by reviewing a series of multiple logistic regression models. Clinical and clinicopathologic variables significantly associated with thrombocytopenia in the final model included increased PCV, increased band neutrophil count, increased total WBC, and decreased plasma protein concentration. Increased mature neutrophil count was associated with normal platelet counts. Thrombocytopenic horses were significantly more likely to die to be euthanized than were horses with normal platelet counts.

Animals↗
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A retrospective case-control of acute renal failure in 99 dogs.

The objective of this study was to evaluate retrospectively demographic and clinicopathologic factors that may be associated with the diagnosis and outcome of acute renal failure (ARF) in dogs presented to a large referral hospital. Medical records of dogs presented to the hospital were searched for a diagnosis of ARF. The diagnosis of ARF was based on clinical signs, renal imaging findings, and clinicopathologic data and, in most cases, was confirmed by histopathology, prior serum creatinine concentrations, response to therapy, and known recent nephrotoxin exposure or ischemic event. Demographics, selected clinicopathologic findings, and concurrent disorders that may have been associated with development of ARF were extracted from these records. A reference population was derived from 481 dogs presenting to the same hospital. Demographic data also were collected from these medical records. The demographic factors associated with a diagnosis of ARF and the factors associated with outcome of ARF were assessed by reviewing a series of multiple logistic regression models. Conclusions from this study were as follows: (1) Intact male dogs and nonsporting dogs were more likely to develop ARF and be admitted to the teaching hospital. (2) Dogs with severe azotemia (serum creatinine concentration > 10 mg/dL), hypocalcemia (< 8.6 mg/ dL), and proteinuria were less likely to survive ARF and be discharged from the hospital. (3) Dogs that survived in the hospital for more than 5 days were more likely to recover and be discharged from the hospital.

Acute Kidney Injury↗
PubMedDate not supplied

Redistribution of cerebral blood flow following STA-MCA by-pass in patients with hemispheric ischemia.

Regional cerebral blood flow and vasomotor reactivity were measured in 33 patients with surgically remediable hemispheric ischemia by the 133Xe inhalation method prior to superficial temporal to middle cerebral artery (STA-MCA) by-pass. Thirteen patients also underwent LCBF and L lambda measurements by the stable xenon CT method for comparison. Twenty-four had proximal occlusion of one or both internal carotid arteries, 9 had intracranial occlusive disease (4 internal carotid, 5 middle cerebral). Measurements were repeated at intervals up to 30 months following surgery and compared to measurements in a similar group (N = 13) treated medically. In the surgically treated group 22 patients had recurrent TIAs, of whom 12 also had minor residual neurological deficits from recent small cerebral infarctions with potential for recovery (RINDs) while the remaining 11 had RINDs without TIAs. After surgery 28 improved with cessation of TIAs and/or neurological recovery, 3 remained unchanged, 2 cases worsened. Compared to age-matched normal hemispheric F1 (gray matter) values, pre-operative F1 values in the STA-MCA group were reduced in both ischemic and opposite hemispheres. Ischemic regions showed imparied vasomotor reactivity to 5% CO2 or 100% O2 inhalation. After surgery, mean hemispheric F1 values increased + 12.8% on the by-pass side and + 10.5% on the contralateral side. Mean F1 increases reached a maximum 3 months after by-pass, most evident in ipsilateral frontal regions (+ 24.2%). Vasomotor reactivity did not significantly improve. Medically treated cases did not show similar F1 increases. Thirteen with carotid occlusive disease (8 with TIAs, 5 with small recent infarcts) underwent CT LCBF and L lambda measurements before and after STA-MCA by-pass. Cases with recent infarcts showed reduced LCBF and L lambda values which increased significantly after STA-MCA by-pass, however the total group operated upon showed only trends for CBF increases, probably due to large standard deviations encountered in serial measurements.

Aged↗
PubMedDate not supplied

Serum vitamin K concentration in pediatric patients receiving total parenteral nutrition.

The only multivitamin preparation for total parenteral nutrition currently available in the United States that contains vitamin K is the pediatric formulation MVI-Pediatric. The recommended dose provides 200 micrograms of vitamin K1 per day to term infants and children up to 11 years old. This dose is well above the recommended dietary allowance of approximately 1 microgram/kg per day, but the losses of vitamin K during administration are unknown. We evaluated the stability of vitamin K1 in a standard total parenteral nutrition infusion and found that an average 72.7 +/- 4.9% of the original vitamin K1 was present after 24 hours. By using high-performance liquid chromatography with electrochemical reduction and fluorescence detection, we obtained the serum vitamin K1 concentrations in 11 pediatric patients receiving total parenteral nutrition with MVI-Pediatric (Rorer Pharmaceuticals, Fort Washington, PA) supplementation and in control children. The serum vitamin K1 concentration (19.3 +/- 12.2 ng/mL) in patients receiving MVI-Pediatric is significantly higher than that in control children 1.9 +/- 1.5 ng/mL (p < .001). Current practice results in excessive levels of vitamin K in pediatric patients.

Catheterization, Central Venous↗
PubMedDate not supplied

Use of severity-adjusted length of stay to modify physician practice patterns.

OBJECTIVE: To compare inpatient length of stay among physicians by testing a new method for severity adjusting length of stay. DESIGN: A retrospective validation study with prospective follow-up after an intervention. SETTING: A 531-bed community teaching hospital. PATIENTS: Three hundred randomly selected patients from the 30,861 patients discharged in 1990. INTERVENTION: A physician with a significantly prolonged severity-adjusted length of stay was counseled and then monitored for three months. RESULTS: The correlation between the number of comorbidities, complications, and manifestations of disease processes (CCMDPs) was R2 = 0.658, t = 23.96 (p = .001). One physician had an unusually high severity-adjusted length of stay, but lowered it after he was counseled and monitored for three months. CONCLUSIONS: The number of CCMDPs recorded on the hospital discharge abstract can be used as a severity index to adjust a patient's length of stay for illness severity. Using linear regression analysis, a picture of the severity-adjusted length of stay can be derived for physicians. Through counseling and monitoring, individual physicians' lengths of stay patterns may be reduced.

Comorbidity↗
PubMedDate not supplied

Practical ophthalmic microbiology.

Infection is commonly encountered in everyday ophthalmic practice. It is of great importance that all ophthalmic personnel are familiar with the basic etiologies of these infections, and the basic techniques which are used in diagnosis. When evaluating a patient with possible infection, it is often of great help to be familiar with the normal microbial flora of the human body. This normal flora has been detailed in the article. The assumption is that knowledge of a patient's flora can help guide decisions about the possible etiologies of an infection. When presented with an obvious ocular infection, health care personnel should review the "usual suspects"--that is, the common etiologies for each type of infection. The key to combating ocular infections lies in accurate treatment of the presumed infectious agent. Therefore, the techniques and steps used in the identification of the etiology of an infection should be known to all ophthalmic personnel. The proper sterile techniques of obtaining a specimen from a suspected corneal ulcer or conjunctivitis and the plating of the specimen on specific agar for identification are essential to everyday practice (Figure 8). Patients who will undergo surgery, regardless of the type, are being placed at a special risk for infection. These post-operative infections can destroy the work of the most careful and exact surgical technique. It is an essential part of the procedure that the patient be protected as best they can from subsequent infection. The techniques to reduce the risk of post-operative infection have been detailed above. Proper preparation of a sterile field, sterile draping, and perioperative antibiotics can reduce the chance of a subsequent infection. It is important that these basic steps of care be properly provided to help insure successful surgical outcomes and excellence in health care.

Eye Infections, Bacterial↗
PubMedDate not supplied

Detection of the complement (CD21)/Epstein-Barr virus receptor in human lacrimal gland and ocular surface epithelia.

CD21, the receptor for the C3d complement fragment, has been reported to be the Epstein-Barr virus (EBV) receptor in B lymphocytes and cultured squamous epithelial cells. This receptor has previously been found to be expressed in the epithelia of nonocular mucosal-associated lymphoid tissues (MALT) which are also sites of persistent EBV infection. We recently found evidence of persistent EBV infection in human ocular MALT and hypothesized that the epithelia in these tissues may also express the complement (C3d)/EBV receptor. To test this hypothesis, histologic sections of human lacrimal gland, ocular surface tissue (conjunctiva, limbus, and cornea), and conjunctival impression cytology specimens were stained by immunohistochemical techniques using three different anti-CD21 monoclonal antibodies (HB-5, B2, OKB7). HB-5 stained lacrimal gland ductal and all ocular surface epithelia, except limbus. B2 stained lacrimal gland ductal and limbal epithelia, and OKB7 stained only the limbal and corneal epithelia. The intensity of limbal and corneal epithelial staining with all anti-CD21 antibodies correlated with the level of epithelial differentiation, with the weakest staining noted in the cells which are thought to be the stem and transient amplifying cells of the cornea. These results suggest that external ocular tissues, similar to other MALT, have CD21-positive epithelia which may be potential targets for EBV infection.

Antibodies, Monoclonal↗
PubMedDate not supplied

Combined modality therapy of locally advanced breast cancer. One institution's experience and a review of the literature.

Fourteen patients with locally advanced breast cancer were treated at Stanford University Medical Center with a combined modality approach. Treatment consisted of an initial 5 day course of cyclophosphamide followed by three cycles of combination chemotherapy (CAF or CMF). Patients subsequently received radiation therapy to the involved breast and regional nodal areas, followed by mastectomy if resistant disease was present following irradiation. Additional chemotherapy (CMF) was administered for 6 cycles. With a median follow up of 42 months, all fourteen patients are free of local disease. Five out of the fourteen patients have experienced distant relapses and two patients died. We conclude that an aggressive combined modality approach to treatment of locally advanced breast cancer can result in excellent local control and survival even in poor prognosis patients. A review of pertinent studies on multimodality treatment for locally advanced breast cancer confirms our findings.

Antineoplastic Combined Chemotherapy Protocols↗
PubMedDate not supplied

Use of the infrapatella strap in the treatment of patellofemoral pain.

The spectrum of patellofemoral disorders ranging from chondromalacia of the patella to degenerative arthritis is a difficult, often vexing problem. Many methods of treatment, both surgical and nonsurgical, have been used without uniform or predictable success. The infrapatella strap, a new concept in nonsurgical management of patellofemoral pain, can be effective in 77% of patients. Its simplicity and comfort, patients' acceptance, and the apparent lack of contraindications when it is worn as instructed justify further clinical trials.

Adolescent↗
PubMedDate not supplied

Erythema migrans-like rash illness at a camp in North Carolina: a new tick-borne disease?

BACKGROUND: Borrelia burgdorferi, the causative agent of Lyme disease, has never been isolated from a patient thought to have acquired Lyme disease in any southeastern state. OBJECTIVE: To investigate 14 cases of an erythema migrans (EM)-like rash illness that occurred during 2 summers at an outdoor camp in central North Carolina in an effort to determine the etiologic, epidemiological, and clinical aspects of this illness. METHODS: Using active surveillance, we identified cases of clinically diagnosed EM in residents and staff of the camp. We collected clinical and demographic information; history of exposure to ticks; acute and convalescent serum antibodies to B. burgdorferi, Rickettsia rickettsii, and Ehrlichia chaffeensis; and cultures for spirochetes from biopsy specimens of skin lesions. Serum samples from a group of residents and staff who did not develop rashes were tested for the same antibodies. We speciated ticks removed from people and collected from vegetation. RESULTS: We identified 14 cases of EM-like rash illness during the 2 summers. Of the 14 case-patients, 10 had associated mild systemic symptoms and 1 had documented fever. All 14 case-patients had removed attached ticks, and 8 remembered having removed a tick from the site where the rash developed a median of 12 days earlier (range, 2-21 days). One tick removed from the site where a rash later developed was identified as Amblyomma americanum, the Lone Star tick; 97% of ticks collected from vegetation and 95% of ticks removed from people were A. americanum. No spirochetes were isolated from skin biopsy specimens. Paired serum samples from 13 case-patients did not show diagnostic antibody responses to B. burgdorferi or other tick-borne pathogens. CONCLUSIONS: This investigation suggests the existence of a new tick-associated rash illness. We suspect that the disease agent is carried by A. americanum ticks. In the southern United States, EM-like rash illness should no longer be considered definitive evidence of early Lyme disease.

Adolescent↗