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Biomedical subjects

M H Levy

Publications and source records attributed to M H Levy.

At least 37 records · Page 2Linked to original sources
PubMed1996

Progressive subretinal fibrosis and blindness in patients with multifocal granulomatous chorioretinitis.

PURPOSE: To describe the clinical and histopathologic findings in four eyes of three patients who became blind because of multifocal choroiditis and massive subretinal fibrosis. METHODS: Clinicopathologic correlative study. RESULTS: During a period of several years, three healthy elderly patients developed severe visual loss only partly explained by multifocal chorioretinitis and massive subretinal fibrosis. Histopathologic examination of four eyes from these patients disclosed widespread destruction of the outer retina and retinal pigment epithelium, massive areas of subretinal fibrous tissue proliferation, granulomatous inflammation centered around degenerated and fragmented Bruch's membrane, and chronic uveitis. No infectious organisms were identified by special stains or electron microscopy in one eye. CONCLUSIONS: Clinical and histopathologic findings in these three patients were consistent with an autoimmune disease process directed at the retina, retinal pigment epithelium, inner choroid, or all three. Cellular injury in this location can result in massive subretinal fibrosis. Subretinal fibroplasia, however, is probably a nonspecific reparative response to injury. The pathogenesis of this blinding disorder in elderly patients may be similar to the less severe disease usually occurring in younger patients with multifocal choroiditis, panuveitis, and punctate inner choroiditis.

Aged↗
PubMed1995

Inhibition of HIV-1-induced syncytia formation and infectivity by lipophosphoglycan from Leishmania.

In HIV-1 infection, the appearance of syncytia-inducing (SI) isolates is associated with a more rapid decline of CD4+ cells and progression to AIDS. Agents that inhibit either virus infection or syncytia formation have the potential to be therapeutically useful. Lipophosphoglycan (LPG), the major glycoconjugate of Leishmania, was recently shown to be a potent nonspecific inhibitor of viral membrane fusion. In this study, LPG demonstrated a dose-dependent inhibition of HIV-1-induced syncytia formation in CD4+ MT-2 cells infected with distinct SI isolates. Fragments of LPG were used to show that inhibition of syncytia formation was dependent on the length of the LPG fragment. Treatment of CD4+ cells or HIV-1 isolates with LPG inhibited infection in vitro. Furthermore, LPG inhibited the replication of SI viral isolates in CD4+ T cells in vitro. LPG had no toxic effects on peripheral blood mononuclear cells at the highest concentrations used in these assays. Further, LPG rapidly associated with the surface membrane of a human T cell line and subsequently disassociated over a 24-h period. The development of compounds capable of inhibiting HIV-induced syncytia formation should provide novel therapeutic approaches to control the spread of virus and disease progression.

Animals↗
PubMed1994

Notification of infectious diseases by general practitioners in New South Wales. Survey before and after the introduction of the Public Health Act 1991 (NSW)

OBJECTIVE: To evaluate attitudes and knowledge about infectious disease notification and the self-reported notifying practices of general practitioners in New South Wales before and after the introduction of the Public Health Act 1991 (NSW). DESIGN: A survey of a random sample of general practitioners in NSW before and after the introduction of the Act. RESULTS: The percentage of doctors who considered notification to be very important increased (57% "before" v. 67% "after"; P = 0.02), as did the percentage who believed that notification usually leads to preventive action (41% v. 54%; P = 0.04). There was no increase in self-reported notification (50% v. 54% who reported notifying cases of notifiable diseases "always, or almost always"; P = 0.42). CONCLUSIONS: Notification of infectious disease by doctors remains suboptimal, but may improve over time as the impact of the new Act is felt. Feedback to doctors showing that preventive action is taken as a result of their notifications may be the most effective way to improve notification practices.

Attitude of Health Personnel↗
PubMed1994

Pharmacologic management of cancer pain.

The ideal goal of cancer pain management is the combination of comfort and function. For the vast majority of cancer pain patients, this balance can be achieved with individually titrated opioid analgesics and specifically prescribed coanalgesics. Integration of pain blocking procedures and cognitive behavioral therapies can further enhance the quality of life of selected patients. Comprehensive cancer pain management should be offered in concert with anticancer therapy and shares many of its constructs: prevention, early detection, specific therapy, combination chemotherapy, dose intensity, combined modalities, and psychosocial support. Unlike the control of cancer, the tools to effectively control cancer pain are readily available. Their use takes time, skill, and commitment and should be the very least that is provided to all cancer patients and their families.

Analgesics↗
PubMed1993

The prevalence of tuberculosis infection in New South Wales police recruits, 1987-1990.

OBJECTIVE: To determine the prevalence of tuberculosis (TB) infection and to determine the rate of conversion to a positive Mantoux test result after BCG vaccination in a subgroup of the Australian population. DESIGN: A descriptive and retrospective study. SETTING: The Police Academy, Goulburn, New South Wales. PARTICIPANTS: 4704 recruits to the New South Wales Police Service between 1987 and 1990. MAIN OUTCOME MEASURES: Rates of positive Mantoux test results before and after administration of BCG. RESULTS: Eleven per cent of Police Cadets were Mantoux positive. Of those who had never been vaccinated with BCG, 7% were positive. Statistically significant differences in Mantoux positivity were found in relation to age, sex and country of birth. There was also a significant difference in the frequency of positive Mantoux reactions between the group vaccinated with BCG at the Academy and those who were vaccinated earlier in life. CONCLUSIONS: Routine Mantoux testing of population subgroups provides a useful source of information on the prevalence of TB infection. However, without testing for the "booster phenomenon" only a minimum estimation of the infection rate can be determined. The National Health and Medical Research Council recommendation that a Mantoux reaction of 5-9 mm be considered positive in the southern States of Australia is supported. The low rate of conversion to a positive Mantoux test result after administration of BCG vaccine at the Police Academy indicates that Mantoux testing after vaccination is not useful.

Adult↗
PubMed1992

Mycobacterial disease and AIDS in New South Wales.

OBJECTIVE: To determine the coincidence of mycobacterial disease and acquired immunodeficiency syndrome (AIDS), and whether persons with mycobacterial disease and human immunodeficiency virus (HIV) infection differ from those with mycobacterial disease alone, by age, sex and country of birth. DESIGN: A descriptive study. PARTICIPANTS: Persons on the NSW Tuberculosis Register in 1989 and those on the NSW AIDS database in 1982-1989. MAIN OUTCOME MEASURE: Coincident appearance on the Tuberculosis Register and the AIDS database. RESULTS: People with atypical mycobacterial infection and HIV infection were younger and more likely to be male compared with those with mycobacterial disease alone. There was a strong association between mycobacterial disease and HIV infection. Of 438 patients newly diagnosed with mycobacterial disease in 1989, 75 (17.1%) had HIV infection. Of 318 tuberculosis patients, 8 (2.5%) had HIV infection, and of 120 patients with atypical mycobacterial infection, 67 (55.8%) had HIV infection. CONCLUSION: Close monitoring of HIV patients for mycobacterial infection, and chemoprophylaxis for persons infected with HIV who have positive Mantoux test results will assist in the control of mycobacterial disease. HIV testing and counselling should be considered for all persons with mycobacterial disease.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Rabies case in New South Wales, 1990: public health aspects.

OBJECTIVES: To identify the source of rabies in the recent case in New South Wales, and to determine the need for post-exposure rabies prophylaxis among contacts of the patient. DESIGN: Information was obtained by face-to-face interview of the dead girl's family and face-to-face and telephone interviews using a questionnaire of health care workers. Other information was gathered from overseas and local sources through telephone and facsimile contact. RESULTS: The girl had migrated from Vietnam in 1984 to Hong Kong, and from there in 1986 to Australia. No evidence of contact with a rabid animal in Australia or Hong Kong was found. There had also been no organ donations from the girl. Four health care workers were given post-exposure rabies prophylaxis. CONCLUSIONS: Because of the lack of evidence of animal contact in Australia and the fact that extremely long incubation periods for rabies have been documented, it was considered that the most likely source of the rabies virus was North Vietnam. Genetic studies of the virus also supported a South-East Asian source. Nevertheless the presumed incubation period--at least six years and four months--is one of the longest recorded.

Animals↗
PubMed1992

Transdermal fentanyl: seeding trial in patients with chronic cancer pain.

In this study, 6 patients with pain from advanced cancer were enrolled in a multicenter, open-label seeding trial of transdermal fentanyl. Following equianalgesic dose conversion, transdermal fentanyl patches were applied every 3 days. Mean fentanyl dosage doubled by week 2 and tripled by week 4. Pain control improved in all patients. There were no significant changes in mood, constipation, nausea, sedation, daily activities, or interpersonal relationships from pretrial to posttrial analyses. Following the study period, 5 patients were monitored for a mean total of 55 days with a mean final fentanyl dose of 240 micrograms/hr. As part of a comprehensive cancer pain management program, transdermal fentanyl appears to be safe and effective, and should prove to be a useful addition to currently available opioid analgesics.

Administration, Cutaneous↗
PubMed1992

The role of patient education in cancer pain control.

Patient education should be a central component of pain control regimens for cancer patients. Few systematically developed and carefully evaluated pain control patient education programs have been reported. Patient education for cancer pain control should include five phases: assessment, goal setting, selection of educational strategies, implementation and reassessment. Each of these phases should be included to maximize the goals of pain prevention and pain relief.

Humans↗
PubMed1991

Phase II study of weekly 5-fluorouracil, cisplatin and vinblastine in advanced non-small cell lung cancer.

The scheduling of chemotherapeutic agents may be important in optimising their antitumour actions. This has been explored in non-Hodgkin lymphoma, osteogenic sarcoma and bladder cancer with improved results using intensive, weekly dosing schemas. We began a phase II study of cisplatin, 5-fluorouracil and vinblastine in non-small cell lung cancer (NSCLC) on a weekly schedule. 38 patients with advanced or metastatic NSCLC were entered; 32 are evaluable for response. 11 patients were treated with 5-fluorouracil 1.5 g/m2 and vinblastine 4 mg/m2 by 24-h continuous infusion, and cisplatin 30 mg/m2 over 30 min, 6-8 h after the start of the infusion. Because of prohibitive myelotoxicity, the next 27 patients received 5-fluorouracil 1.2 g/m2 and vinblastine 3 mg/m2. None had had prior chemotherapy while 6 had had previous radiation therapy. Myelosuppression was the predominant toxic effect. Other side-effects included neuropathy, diarrhoea, mucositis, nausea and vomiting. 32 patients are evaluable for response: there have been 14 partial remissions (44%). Responses have occurred chiefly in lung and lymph nodes. The median survival on this study is 7 months, and responders did not live longer than non-responders. While this regimen is well tolerated by the majority of patients and has a response rate comparable to other active regimens identified in single institution studies, survival does not appear to be enhanced. We conclude that the schedule manipulation described here does not enhance the therapeutic index of these drugs in NSCLC.

Adult↗
PubMed1991

Reported measles immunisation and serological immunity in children attending general practitioners.

To determine the feasibility of serological testing for measles immunity in children attending general practitioners and to assess the validity of establishing immune status by reported immunisation history compared with serology, a cross-sectional descriptive study was conducted in general practices in the Illawarra area south of Sydney, New South Wales. Participants were 234 children under 15 years attending general practitioners. 87 per cent of children were reported to have been immunised against measles, but 46 per cent of these children were seronegative for measles antibody using an ELISA test on finger-prick blood. This could not be explained by inaccurate reporting of immunisation. No causes other than failure to seroconvert or inadequate specificity of the test on the blood samples were evident. Failure to seroconvert as a result of inadequate adherence to cold chain requirements is a possibility that needs further investigation. The results further question whether a single vaccination is adequate to achieve the public health aims of measles immunisation programs.

Adolescent↗