Search PubMed⌕ Search

Biomedical subjects

J Levy

Publications and source records attributed to J Levy.

At least 145 records · Page 8Linked to original sources
PubMed1996

Mammographically detected breast cancer. Benefits of stereotactic core versus wire localization biopsy.

OBJECTIVE: The authors evaluated the differences between stereotactic core needle biopsy (SCNBx) and needle localization surgical biopsy (NLBx) in cost and treatment course for patients with mammographically detected breast cancer. SUMMARY BACKGROUND DATA: Stereotactic core needle breast biopsy is a reproducible and reliable alternative to surgical biopsy for histologic diagnosis of mammographic lesions. METHODS: Records from 52 consecutive patients with invasive breast cancer diagnosed by SCNBx (n = 21) or NLBx (n = 31) over 2 years were reviewed. Episode-of-care costs were extracted from the Barnes Hospital billing system database. RESULTS: At the time of excision, surgical margins were statistically more frequently positive in patients treated with NLBx (55%) than patients treated with SCNBx (0%, p < 0.0001). Furthermore, patients in the NLBx group undergoing breast conservation surgery required re-excision more frequently (74%) than those in the SCNBx group (0%, p = 0.001). There were no complications in either group after the diagnostic procedure. All SCNBx results were correct in the diagnosis of invasive breast cancer. The median cost of SCNBx was approximately $1000 less than the median cost of NLBx. This cost difference was carried through the definitive procedure, whether it was breast conservation or mastectomy. CONCLUSIONS: This study shows the advantage of SCNBx to diagnose breast cancer and definitive operative care at a single procedure. The preoperative diagnosis of breast cancer eliminated positive operative margins and procedures to re-excise breast tissue. The use of SCNBx also saved approximately $1000 per patient compared with the use of NLBx. Our data suggest that SCNBx is the diagnostic procedure of choice for mammographically detected cancers.

Adenocarcinoma↗
PubMed1996

Speech and swallowing rehabilitation following devastating caustic ingestion: techniques and indicators for success.

Caustic material ingestion, either accidental or intentional, may result in tissue and organ destruction leading to a wide range of complications, including loss of speech and the ability to eat. The esophagus can be reconstructed successfully, but reopening the larynx and upper airway poses a significant therapeutic dilemma. External reconstruction may put the neoesophagus at risk. Loss of the normal swallowing mechanism and the protective supraglottic structures often results in fatal aspiration. The authors present three cases of successful endoscopic laser recannulation of the larynx with esophageal replacement. The discussion includes surgical technique and the tools used to determine the success of the reconstruction, including computed tomographic scanning, modified barium swallow, placement of an upper esophageal anastomosis, psychologic support, and speech and swallowing therapy.

Adult↗
PubMed1996

Reconstructive spinal surgery: assessment of outcome.

One of the foremost problems in evaluating patients who have had spinal surgery is the difficulty in reliably assessing changes in symptoms and function attributable to the operative procedure. In this study, a questionnaire was sent to patients who had had spinal surgery at least 6 months earlier. The data were entered into a data base that contained information about the surgical procedure. Correlation studies were conducted and t tests were used to find statistically significant differences. Seventy-two patients returned the completed questionnaire. The rate of return to work was significantly lower among those involved in workers' compensation or litigation and those with prolonged preoperative unemployment. Depression inversely correlated with satisfaction, the number of dissatisfied patients correlating directly with the number of patients significantly depressed. Physical deconditioning, change in attitude and perception, preinjury job dissatisfaction, secondary gain, and other medical conditions significantly decreased the probabilities of return to work and satisfaction.

Absenteeism↗
PubMed1996

Stimulation of endometrial cancer cell growth by tamoxifen is associated with increased insulin-like growth factor (IGF)-I induced tyrosine phosphorylation and reduction in IGF binding proteins.

A significant increase in endometrial cancer incidence in tamoxifen-treated breast cancer patients has been reported in many recent studies. The major growth stimulators of endometrial tumors are estrogens, but paradoxically, tamoxifen, a known antiestrogen, also stimulates their growth. The mode of action of estrogen can be partially explained by the modulation of insulin-like growth factor (IGF) autocrine or paracrine action. The purpose of the present study was to examine the involvement of the IGF system in the tamoxifen-stimulated growth of Ishikawa endometrial cancer cells by quantitating the IGF-I receptors and their phosphorylation, as well as membrane associated and secreted IGF-binding proteins (IGFBPs). Tamoxifen did not affect the number or affinity of IGF-I receptors. On the other hand, tamoxifen, similar to estradiol, increased IGF-I-stimulated tyrosine phosphorylation of cellular substrates. In contrast, in MCF-7 mammary cancer cells, tamoxifen reduced IGF-induced tyrosine phosphorylation in the presence of estradiol. The pure antiestrogen LY156758 did not affect Ishikawa basal cell growth but inhibited estradiol- and tamoxifen-induced growth. Growth inhibition by LY156758 of tamoxifen and estradiol-stimulated cells was accompanied by a corresponding inhibition of IGF-stimulated tyrosine phosphorylation. Tamoxifen caused a 3-fold decrease in membrane-associated IGFBPs. Moreover, a reduction in soluble IGFBPs was also observed, making the IGF peptides more available to the receptors. A parallel decrease in IGFBP-3 mRNA was also detected. These experiments suggest that tamoxifen, like estradiol, directly sensitizes endometrial cancer cells to the effects of IGFs that act through the type I receptor. Furthermore, the decrease in IGFBPs and the increase in tyrosine phosphorylation in the presence of tamoxifen provides a molecular mechanism that accounts for the uterotropic effects that are seen with tamoxifen therapy.

Antineoplastic Agents, Hormonal↗
PubMed1996

[Venous hemangioma of the temporal muscle. Review of the literature: apropos of a case].

A 41-year-old woman progressively developed a painful tumefaction in the left temporal fossa. The scan showed a isodense intramuscular structure weakly enhanced by contrast medium. Surgical exeresis was performed via the coronal access. Histology of the surgical specimen reported the diagnosis of venous muscular haemangioma. The diagnosis and management of these rare tumours is discussed.

Adult↗
PubMed1996

Maternal plasma and amniotic fluid cortisol and progesterone concentrations between women with and without term labor. A comparison.

OBJECTIVE: The purpose of the present study was to determine the amniotic fluid and maternal plasma concentrations of cortisol and progesterone in nonlaboring women at term and to compare them to those in women with active labor at term. STUDY DESIGN: A prospective, cross-sectional study. Soroka Medical Center of Kupat Holim, Faculty of Health Sciences, Ben-Gurion University of the Negro, Beer-Sheva, Israel. Thirty-five healthy women with normal term pregnancies were classified according to labor status into two groups: group A (16 women with spontaneous, active labor at term) and group B (19 women not in labor). RESULTS: We found a significant increase in the median concentration of plasma cortisol in women at term in active labor in comparison to those not in labor. In addition, the median concentration of cortisol in amniotic fluid in women in labor was also significantly higher than that in women not in labor. In contrast, no significant changes in median maternal plasma or amniotic fluid progesterone concentrations were detected between the groups. CONCLUSION: Human parturition is associated with a significant increase in the concentration of cortisol in both maternal plasma and amniotic fluid. These findings suggest that cortisol plays an important but still-undetermined role in human parturition.

Adult↗
PubMed1996

[Surgical strategy of osteocutaneous free transfer of the fibula in complex mandibular reconstructions: technical notes].

The fibula osteocutaneous free flap now has a recognized place in the therapeutic arsenal of microsurgical mandibular reconstructions. Based on a review of the literature and their own experience, the authors propose a preoperative and intraoperative strategy adapted to reconstructions of mandibular defects. The place of complementary investigations, the site of the skin flap, the choice of osteotomy, the type of fixation, and spatialisation of the skin flap are presented. They conclude on the excellent plastic and vascular qualities of the fibula flap in complex mandibular reconstructions.

Adult↗
PubMed1996

[Vaccination of children in 1996].

Immunization against Haemophilus influenzae b and hepatitis B during infancy, as well as the administration of a second dose of measles-mumps-rubella vaccine around the age of 12, are the significant additions brought to the childhood immunization program in recent years. The availability in the near future of the acellular pertussis vaccines illustrates the efforts made to reduce the side effects associated with the use of some vaccines. The high cost of these acellular vaccines, together with the absence of combined Haemophilus influenzae or hepatitis B vaccines, represent their current limitations.

Bacterial Capsules↗
PubMed1996

[Silastic implants and reconstruction of the orbital floor: review of twenty year's experience].

Fractures of the orbital floor still raise unresolved therapeutic problems concerning the operative indication or the type of material to be used during repair. For this purpose, surgeons have the choice between heterologous or autologous grafts, implants and numerous biomaterials. The authors conducted a retrospective study with a follow-up of 20 years of 137 patients treated in the department for a fracture of the orbital floor using a Silastic implant. The reoperation rate to remove the implant was 13.8%. Various complications were observed: dacryocystitis, migration of the implant to the skin and maxillary sinus, cutaneous fistula, persistent diplopia, orbito-sinus communication, periorbital cellulitis. In view of these complications, it appears preferable to modify the therapeutic approach and propose autotransplantation of the concha for defects less than 1.5 cm2 and autologous parietal bone graft for larger defects.

Adult↗
PubMed1995

Association of Helicobacter pylori and Chlamydia pneumoniae infections with coronary heart disease and cardiovascular risk factors.

OBJECTIVE: To investigate the relation between seropositivity to chronic infections with Helicobacter pylori and Chlamydia pneumoniae and both coronary heart disease and cardiovascular risk factors. DESIGN: Cross sectional study of a population based random sample of men. Coronary heart disease was assessed by electrocardiography, Rose angina questionnaire, and a history of myocardial infarction; serum antibody levels to H pylori and C pneumoniae were measured, risk factor levels determined, and a questionnaire administered. SETTING: General practices in Merton, Sutton, and Wandsworth, south London. SUBJECTS: 388 white south London men aged 50-69. MAIN OUTCOME MEASURES: Evidence of coronary risk factors and infection with H pylori or C pneumoniae. RESULTS: 47 men (12.1%) had electrocardiographic evidence of ischaemia or infarction. 36 (76.6%) and 18 (38.3%) were seropositive for H pylori and C pneumoniae, respectively, compared with 155 (45.5%) and 62 (18.2%) men with normal electrocardiograms. Odds ratios for abnormal electrocardiograms were 3.82 (95% confidence interval 1.60 to 9.10) and 3.06 (1.33 to 7.01) in men seropositive for H pylori and C pneumoniae, respectively, after adjustment for a range of socioeconomic indicators and risk factors for coronary heart disease. Cardiovascular risk factors that were independently associated with seropositivity to H pylori included fibrinogen concentration and total leucocyte count. Seropositivity to C pneumoniae was independently associated with raised fibrinogen and malondialdehyde concentrations. CONCLUSIONS: Both H pylori and C pneumoniae infectins are associated with coronary heart disease. These relations are not explained by a wide range of confounding factors. Possible mechanisms include an increase in risk factor levels due to a low grade chronic inflammatory response.

Aged↗
PubMed1995

Immunohistologic analysis of ineffective CD40-CD40 ligand interaction in lymphoid tissues from patients with X-linked immunodeficiency with hyper-IgM. Abortive germinal center cell reaction and severe depletion of follicular dendritic cells.

The CD40 ligand (CD40L) is an activation-induced surface membrane protein expressed by CD4+ T helper cells in lymphoid follicles, and is involved in the contact-dependent signaling-mediated activation, proliferation, and differentiation of CD40+ B cells. Using immunohistochemistry, the present study analyzes the cell microenvironment of lymphoid tissues in two cases of X-linked hyper-IgM syndrome, a congenital immunodeficiency caused by mutations of the CD40L gene, and which represents a unique model to dissect the functional and morphologic consequences of disrupted CD40/CD40L interactions. Prominent primary B follicles are identified in the lymph nodes and in the extranodal lymphoid tissues from both cases, but tiny collections of Bcl-2-, MIB1/Ki67+ centroblasts are also found in one case. Despite the CD40L defect, intrafollicular CD4+CD57+ T helper cells, identified by anti-parvalbumin mAb, are normally present. However, a severe depletion of follicular dendritic cells, recognized by Abs against NGFR, CD21 and CD23, and lack of expression of the Ag recognized by KiM4p on these cells, are noticed. Finally, no major alterations of the architecture and cellular composition of the paracortical T cell area are found. A large number of plasma cells exclusively expressing IgM were detected in the colon lamina propria in one of the patients, who also had extremely elevated IgM serum levels. Taken together, these data support the idea that ineffective CD40/CD40L interactions determine both abortive germinal center cell reaction as well as severe depletion and phenotypical abnormalities of follicular dendritic cells, thus impairing the functional development of B follicles. Recurrent or persisting antigenic stimulation in mucosal tissues is likely to play a major role in determining and maintaining elevated IgM serum levels.

Adult↗
PubMed1995

Parathyroid hormone decreases in vivo insulin effect on glucose utilization.

Hyperparathyroidism is associated with impaired glucose tolerance, and parathyroidectomy may improve carbohydrate homeostasis. It has been suggested that parathyroid hormone (PTH) suppresses insulin secretion but it is unclear whether it also interferes with the peripheral action of insulin. To evaluate in vivo effects of PTH on insulin-mediated glucose utilization, 15 male Sprague Dawley rats were continuously infused with rat PTH (1-34) using an Alzet miniosmotic pump at a rate of 0.03 nm/hour. Controls were infused with the vehicle alone. Following 5 days of PTH infusion, plasma calcium (Ca) levels were higher in the PTH-infused rats (12.3 +/- 0.2 versus 9.9 +/- 0.1 mg/dl, P < 0.01). On the 5th day, glucose (700 mg/kg) and insulin (0.175 U/kg) were given as a bolus infusion through the left femoral vein, blood samples were obtained from the right femoral vein, and plasma glucose and insulin were measured at basal (0 minutes) and at 2, 5, 10, and 20 minutes postinfusion. Basal, nonfasting glucose levels were higher (166 +/- 4 versus 155 +/- 4 mg/dL, P < 0.04) in the PTH-infused rats but their insulin levels were similar to those of controls (6.5 +/- 0.6 versus 5.6 +/- 0.5 ng/ml). Postinfusions and maximal (2 minutes) glucose and insulin levels were similar in both groups. However, although insulin levels were similar in both groups at all measured time points, glucose levels at 20 minutes were higher in the PTH-treated rats (205 +/- 13 versus 173 +/- 9; P < 0.03).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1995

Does perceptual analysis continue during selection and production of a speeded response?

This study asked whether perceptual analysis of a stimulus can continue while a response to this stimulus is being generated. In Experiment 1, subjects rapidly named a word that was visually degraded with superimposed pixels. Near the time of response, degradation was removed for a short time and then followed by a mask. Subjects then made a second, unspeeded judgment about the identity of the word. Unspeeded judgments were more accurate, showing that the degradation-free stimulus exposure was processed. In Experiment 2, the task was the same, but the degradation was gradually faded out for an individually adjusted duration. Comparison of unspeeded-response accuracy on trials with and without a speeded response showed that stimulus analysis continued at full efficiency during speeded-response generation. The results support conclusions of Rabbit and Vyas (1981) that perceptual analysis continues during response stages. This form of continuous processing does not necessarily contradict discrete stage models of human information processing, however.

Adult↗
PubMed1995

Glucose tolerance in rural diabetic Thais, first-degree relatives and non-diabetic controls.

To determine whether non-insulin-dependent diabetes mellitus (NIDDM) in a rural Thai population is characterised by insulin resistance and hyperinsulinaemia, 17 unselected diabetic outpatients from a regional hospital, five first-degree relatives and 10 healthy controls were studied. Subjects in these groups were matched as closely as possible for age and sex, and mean body mass indices were similar (mean +/- S.D.; 21.8 +/- 5.5, 20.6 +/- 1.4 and 21.8 +/- 2.3 kg/m2, respectively, P > 0.5). Beta-cell function (%B) and insulin sensitivity (%S), expressed relative to values for non-diabetic Caucasians, were assessed mathematically using the 'CIGMA' model and plasma glucose and insulin achieved after a standard 1-h glucose infusion. The diabetic patients had higher fasting plasma glucose concentrations than the controls (8.6 +/- 4.0 vs. 4.6 +/- 0.4 mmol/l, P < 0.01) but plasma insulin levels were comparable (geometric mean [-S.D.-+S.D.]; 4.0 [1.7-9.4] vs. 4.0 [1.7-9.2] mU/l, P > 0.1). %B in the diabetic group (21% [10-41]) was lower than in the controls (128% [88-187], P < 0.001) while %S tended to be higher (185% [86-400] vs. 111% [49-251], 0.1 > P > 0.05). Relatives had intermediate values of both variables. %S and %B correlated poorly in the diabetic group (P > 0.1) but together accounted for 90% of the variation in basal plasma glucose (multiple r = 0.95, n = 17, P < 0.0001). Beta-cell dysfunction appears the primary defect in diabetic patients from a Thai subsistence farming population. Insulin resistance may not always characterise NIDDM in geographical areas where a 'thrifty genotype' would be expected; other factors associated with diabetes in developing countries (such increased susceptibility to serious infections) may also influence diabetes prevalence.

Adult↗
PubMed1995

Insulin versus glipizide treatment in patients with non-insulin-dependent diabetes mellitus. Effects on blood pressure and glucose tolerance.

Insulin resistance that exists in patients with essential hypertension and in those with non-insulin-dependent diabetes mellitus (NIDDM) may be the common denominator for the impaired glucose homeostasis and elevated blood pressure (BP) levels in patients with NIDDM. Therefore, treatment that improves insulin action may also improve BP levels. Consequently, a four-phase (glipizide v insulin) cross-over design study was conducted to determine a better effect of glipizide treatment on insulin sensitivity and the effect this has on BP in 19 NIDDM patients. Patients were subjected to 1 month of diet only (phase I) followed by 3 months of glipizide treatment (phase II), then an additional 1 month of diet only (phase III), and finally 3 months of insulin treatment (phase IV). At the end of phases I, II, and IV oral glucose tolerance tests (OGTT) were performed and plasma glucose, insulin, and C-peptide levels were analyzed. Fasting plasma glucose, insulin, total cholesterol, high density lipoprotein cholesterol, low density lipoprotein cholesterol and triglycerides, glycated hemoglobin, fructosamine, and 2-h postprandial plasma glucose were also analyzed at each phase. Supine and sitting BP levels and body weights were determined biweekly during the study. With the exception of higher plasma insulin and C-peptide levels during the OGTT (area under the curve) in phase IV (insulin) v phase II (glipizide) (both P < .05), and higher fasting plasma insulin levels (P < .06), there were no consistently significant metabolic differences between phases IV and II.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Components of the IGF system mediate the opposing effects of tamoxifen on endometrial and breast cancer cell growth.

The involvement of the IGF system in the growth regulation of hormone-dependent (e.g. endometrial and breast) cancer cells was studied. We chose two opposing effects of tamoxifen: the paradoxical stimulation of Ishikawa endometrial cancer cells growth and its inhibitory effect on MCF-7 mammary cancer cells. The results clearly confirm our working hypothesis that the IGF system is involved in growth regulation of these cancer cells irrespective of the direction of the drug effect. The following parameters of the IGFs system were studied: IGF-I receptors, IGF-I stimulated protein tyrosine phosphorylation, and membrane-associated and secreted IGF-binding proteins (IGFBPs). In Ishikawa cells, tamoxifen, similar to estradiol, increased IGF-I stimulated tyrosine phosphorylation of cellular substrates in accordance with its effect on cell growth. This effect of tamoxifen was inverted in MCF-7 cells. Tamoxifen did not affect the number or affinity of IGF-I receptors in both Ishikawa and MCF-7 cells, however, it caused a three-fold decrease in membrane-associated IGFBPs in the endometrial cells but an increase in these proteins in breast cancer cells. Similar but much less pronounced changes in soluble IGFBPs were observed. Our results indicate that the opposing growth effects of tamoxifen an endometrial and mammary cancer cells are associated with modulation of the IGF system components, mainly with reciprocal changes in membrane-associated IGFBPs.

Breast Neoplasms↗
PubMed1995

Effect of prolonged use of inhaled steroids on the cellular immunity of children with asthma.

BACKGROUND: Systemic corticosteroids may affect the cellular immunity, but there is no available controlled data on such effects associated with a prolonged use of inhaled corticosteroids. OBJECTIVE: The investigation was designed to study the effect of long-term inhaled beclomethasone dipropionate in daily doses of up to 600 micrograms on cellular immune functions. METHODS: Twenty-four children with asthma treated with inhaled beclomethasone dipropionate for a mean of 22.6 months were compared with 16 children with asthma not treated with an inhaled steroid and with 20 healthy adults. Cellular immune parameters included differential white blood count, T- and B-cell numbers, T helper and suppressor counts, T-cell mitogenic transformation, and interleukin-1 and interleukin-2 secretion. RESULTS: There was no difference in any of the studied cellular immune functions among the three study groups. CONCLUSION: Long-term use of inhaled beclomethasone dipropionate by children with asthma, at daily doses of up to 600 micrograms, has no effect on certain parameters of cellular immunity.

Administration, Inhalation↗