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Biomedical subjects

N B Levy

Publications and source records attributed to N B Levy.

At least 37 records · Page 2Linked to original sources
PubMed1990

Psychopharmacology in patients with renal failure.

The prescription of medications for a patient with kidney failure requires special consideration since the kidneys are major organs of excretion and regulator the body's fluid environment. Physicians need to have a working knowledge of the pharmacokinetics of the medications they intend to prescribe. Protein binding of medications is a central factor, especially in end-stage kidney disease where its impairment is associated with higher available drug levels. Fortunately, almost all psychotropics are fat soluble, are excreted by the liver and are not dialyzable. Lithium is an exception, but it may be used because it is totally excreted by the kidneys and its dialyzability enables single dosing after dialysis runs. Some benzodiazepines such as diazepam have active metabolites and their use should be avoided. The general rule is that no more than two-thirds of the maximum dose for a patient with normal renal function should be the maximum dose for a hemodialysis patient and that drug levels should be performed at least monthly and immediately after initial dosing.

Humans↗
PubMed1989

Effects of storage conditions on lymphocyte phenotypes from healthy and diseased persons.

Anticoagulant and room temperature storage of peripheral blood was evaluated in healthy and diseased persons (AIDS and CLL) for its effect upon lymphocyte phenotyping by flow cytometry. Whole blood was stored in either Li heparin, EDTA, or ACD for up to 96 hours. Aliquots at 5 time intervals were evaluated using CD3, CD2, CD4, CD8, and CD19 monoclonal antibodies. Blood from healthy donors stored in EDTA produced an apparent increase in T cells and decrease in B cells most evident by 96 hours storage. Blood from diseased persons stored in Li heparin up to 96 hours showed insufficient changes in phenotype to warrant a different clinical interpretation. We conclude that all three anticoagulants are adequate for short term (less than 24 hr) room temperature transport and storage of peripheral blood for flow cytometry. Li heparin or ACD are more appropriate if prolonged transport times are anticipated.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Psychosomatic medicine and consultation-liaison psychiatry: past, present, and future.

Although "psychosomatic medicine" and "consultation-liaison psychiatry" are imprecise terms, they continue to be useful in describing, respectively, theoretical constructs of the relationship between psychiatry and the rest of medicine and the day-to-day applications of these constructs. The history of these fields encompasses many contributions of psychoanalysis, including the formulation of specificity theory and the somotopsychic-psychosomatic process, as well as the work of Henry, Gregg, and Engel. Currently, their scope incorporates a large and expanding group of physical illnesses and clinical settings. Like the rest of medicine, these fields will continue to feel the effects of reduced federal support, a consumer-oriented society, and increased regulation. However, with advances in psychosomatic theory and broader clinical and research activity, including that stemming from biological psychiatry, the future of psychosomatic medicine and consultation-liaison psychiatry seems positive.

Consultants↗
PubMed1988

Effects of medical advances and political climate upon psychonephrology.

Two relatively recent medical advances have enlarged the options open to patients with renal failure. Continuous ambulatory peritoneal dialysis (CAPD), a form of home care that does not utilize the circulatory system, offers an alternative to those with vessel access compromise. Cyclosporine, a new, but expensive immunosuppressant, has substantially improved chances of success of renal transplantation. However, on the negative side, the federal government has attempted to diminish its expenditure in support of treatment of renal failure by favoring less costly modalities and diminishing its reimbursement of physicians and facilities. Patients are pressured into less expensive forms of treatment, such as CAPD and home hemodialysis, at times with little regard for individual needs. Diminished reimbursement places a greater financial burden upon not-for-profit centers over those that are proprietary.

Adaptation, Psychological↗
PubMed1988

Treatment of B cell malignancies with 131I Lym-1 monoclonal antibodies.

Lym-I is a murine IgG2a monoclonal antibody (MAb) that is B-cell specific but has greater avidity for malignant B cells when compared with normal B lymphocytes. It was originally produced by immunizing mice with nuclei of cultured cells from a patient with Burkitt's lymphoma. Ten patients with progressive refractory B-cell malignancies were treated with 131I-labelled Lym-I. Treatment with 131I Lym-I produced complete or partial remissions in 4 patients. Toxicity did not occur or was mild in most patients. The only significant complications included two instances of fistula secondary to necrotic lymphoma and one instance of hypotension. Human antimouse antibodies occurred in only 2 patients after multiple injections of Lym-I antibody. This experience was in contrast to treatment of B-cell malignancies with unconjugated Lym-I alone. Unconjugated Lym-I also caused no significant toxicity but was less effective than 131I Lym-I.

Antibodies, Monoclonal↗
PubMed1987

Mast cell disease followed by leukemia with clonal evolution.

A 29-yr old woman developed urticaria pigmentosa which subsequently progressed through systemic mastocytosis to Philadelphia chromosome negative (Ph neg) chronic myelogenous leukemia (CML) with t(8;17). Further cytogenetic evolution occurred at the time of transformation to the aggressive phase of the disease. Unlike Ph-positive CML, chromosome number 9 was not involved, nor was the breakpoint cluster region located at band 22q11. This clearly separates this case from other Ph-negative CML patients who do have involvement of 9q34 or the breakpoint cluster region. Since this is the first case of its type to be reported with cytogenetic abnormalities, the clinical relevance of the unique chromosomal rearrangement t(8;17)(p11;q25) in the setting of systemic mastocytosis is unclear. Additional cases need to be reported to determine if this genetic rearrangement is a nonrandom marker of leukemia evolving in a setting of malignant mast cell disease.

Adult↗
PubMed1985

AIDS serology testing in low- and high-risk groups.

The performance characteristics of the acquired immunodeficiency syndrome (AIDS)-retrovirus serological tests including enzyme-linked immunosorbent assay (ELISA), Western blot, and immunofluorescence assay were defined in a clinical laboratory setting by testing 1,257 serum specimens from low- and high-risk groups for AIDS. The three prototype AIDS retroviruses (lymphadenopathy-associated virus, human T-lymphotropic virus III, and AIDS-associated retrovirus) were equally suitable as target antigen for these assays. Sera from six of 74 laboratory and health care personnel and 91 of 1,014 unselected blood donors were falsely positive by ELISA (positive to negative ratio [P/N], greater than or equal to 2) based on the lack of Western blot confirmation. Only two true-positives (two [0.2%] of 1,014 blood donors) were detected in these low-risk groups. In contrast, 106 of 108 specimens with ELISA P/N ratios of 2 or greater from the high-risk groups including asymptomatic homosexual men, hemophiliacs, AIDS-related complex patients, and AIDS patients were positive by Western blot and immunofluorescence assay. Four false-negative ELISA results based on positive immunofluorescence assay and Western blot were found in the AIDS patient group. Ten of 69 AIDS patients were negative by all three serological tests. The consequence of maintaining high sensitivity for the ELISA (P/N ratio, greater than or equal to 2) as a screening test was a loss of specificity. The number of false-positive results necessitated the use of a confirmation test with greater specificity.

Acquired Immunodeficiency Syndrome↗
PubMed1984

Chronic ectopic pregnancy. A survey of 54 cases.

The diagnosis of chronic ectopic pregnancy is very often difficult. The subtle and long-standing symptoms, the relative paucity of clinical signs and the high incidence of false-negative results of relevant investigations contribute to the mimicry of many other intraabdominal conditions by chronic ectopic pregnancy. Surgery for chronic ectopic implantation is frequently difficult since chronic inflammatory changes involving the bladder, bowel and ureters distort the normal anatomy, and the incidence of postoperative complications is high. There is a surprising shortage of literature in which this disease is recognized as an entity separate from the condition of acute ectopic pregnancy.

Adolescent↗
PubMed1983

T-lymphocyte subsets in lymph nodes from homosexual men.

To evaluate further the immunodeficiency of homosexual men, blood and lymph node specimens were obtained from five homosexual men with lymphadenopathy and from seven homosexual men with Kaposi's sarcoma. Monoclonal antibodies were used to identify T-lymphocyte subsets in blood by cytofluorometry and in frozen sections of nodes by immunoperoxidase techniques. The homosexuals with Kaposi's sarcoma had a T-helper/suppressor ratio in blood of 0.7; the homosexuals with lymphadenopathy had a ratio of 0.6, compared with controls of 2.1. Control lymphoid tissue had a ratio of 3.0 in the interfollicular areas compared with the reactive lymph nodes in the homosexuals with lymphadenopathy, which was 0.7, and nodes from patients with Kaposi's sarcoma, 0.9. The nodes from homosexual men had evident numerous suppressor cells in the follicular center and mantle regions, locations in normal lymphoid tissue where suppressor cells were uncommon.

Flow Cytometry↗
PubMed1983

An immunohistochemical study of hemoglobin A, hemoglobin F, muramidase, and transferrin in erythroid hyperplasia and neoplasia.

The bone marrow biopsy specimens of 35 patients with benign and malignant erythroid hyperplasias were examined for the presence of hemoglobin A, hemoglobin F, muramidase (lysozyme), and transferrin, using an indirect immunoperoxidase method (PAP) on Zenker's-fixed paraffin-embedded bone marrow biopsy specimens and particles. Five cases of each of the following entities were studied: erythroleukemia and erythremic myelosis, acute granulocytic leukemia with maturation (FAB M2), polycythemia rubra vera, myeloproliferative syndrome in childhood, megaloblastic anemia (B12 and folate deficiency), erythroid hyperplasia (regenerating bone marrow and hemolytic anemia), and Ph' chromosome positive chronic granulocytic leukemia. Hemoglobin A was present in both the early and late erythroid precursors in all conditions. Hemoglobin F was the predominant hemoglobin in early erythroblasts of pernicious anemia and in both early and late erythroid elements in erythroleukemia and erythremic myelosis. Small quantities of hemoglobin F were present in a few isolated clusters in other conditions. Staining for hemoglobin F may be useful in identifying immature erythroid precursors and in distinguishing some cases of dysplastic erythroid hyperplasia from neoplasia. Additionally, these findings suggest that the maturational switch in hemoglobin synthesis operates with distinct pathways under different conditions.

Bone Marrow↗
PubMed1983

Sexual dysfunctions of hemodialysis patients.

Our knowledge of the sexual dysfunctions of patients with renal failure is in a relatively early phase. We have only recently proceeded to know what are some of their sexual dysfunctions. A good deal of the answers while lie ahead must be in the field of renal endocrinology which still is in its earliest phases. The little that we know is largely restricted to the male and the dysfunctions of females, in many cases much can be done to improve this important aspect of life.

Adult↗