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Biomedical subjects

P Levy

Publications and source records attributed to P Levy.

At least 91 records · Page 5Linked to original sources
PubMed1992

Detection of serum HBV-DNA by polymerase chain reaction (PCR) in patients before reactivation of chronic hepatitis B.

Reactivation of chronic hepatitis B is characterized by the reappearance of HBV-DNA in serum. The purpose of the study was to determine whether, before reactivation, HBV-DNA would be detectable in serum, using a sensitive procedure of detection, namely polymerase chain reaction (PCR). We studied 17 patients with chronic hepatitis B who experienced an episode of reactivation, defined by the reappearance of HBV-DNA in serum. None of these 17 sera had HBV-DNA demonstrable by dot-blot hybridization nor liquid hybridization in sera collected before reactivation. Using PCR, HBV-DNA was detected, before reactivation, in 13 of the 17 episodes of reactivation tested with Southern-blot and hybridization. HBV-DNA was not detectable with PCR in the serum of four patients who subsequently experienced an episode of reactivation. In conclusion, our results show low level HBV replication before reactivation in most, but not all, HBs-positive, HBV-DNA-negative patients. This suggests that reactivation may occur even in patients with no HBV-DNA demonstrable in serum with PCR prior to reactivation.

Adult↗
PubMed1992

Functional status and clinical findings in patients with Alzheimer's disease.

We analyzed the association of clinical findings with impaired functional status, i.e., activities of daily living (ADLs), in a sample of 240 patients diagnosed with Alzheimer's disease by NINCDS/ADRDA or DSM-III-R criteria. Logistic regression models were used to determine independent predictors of both the number of ADL impairments and number of ADL impairments characterized as moderate to severe. Two psychiatric problems, behavioral disorders and apathy, as well as a history of hypertension were significantly associated with ADL impairment independent of age, sex, race, and cognitive impairment. Behavioral disorders and apathy were also significantly associated with moderate to severe ADL impairment, but hypertension was not significant at this level.

Activities of Daily Living↗
PubMed1992

Severe family violence and Alzheimer's disease: prevalence and risk factors.

This study describes the prevalence of violence and the putative risk factors for violence in 184 Alzheimer patients and their primary caregivers living in the community. Analysis of the severe violence subscale of the Conflict Tactics Scale indicated that 15.8% of patients had been violent in the year since diagnosis. A total of 5.4% of caregivers reported being violent toward the patient. The overall prevalence of violence was 17.4%. The variables most associated with violence were caregiver depression and living arrangement.

Aged↗
PubMed1992

Are there clinical differences between familial and nonfamilial Alzheimer's disease?

OBJECTIVE: The purpose of the study was to determine whether there are differences in clinical characteristics in two groups of patients with Alzheimer's disease, those reported to have a family history of dementia and those without a family history of dementia. METHOD: Using a data set from an Alzheimer's disease patient registry, funded as part of a National Institute on Aging cooperative agreement, the authors made comparisons of sociodemographic and clinical variables in a group of 462 patients with Alzheimer's disease, 172 reported to have at least one first-degree relative with dementia and 290 classified with no family history. RESULTS: Patients with a presumptive family history differed from those without a family history in two ways: the course of dementia was described as having a fast rather than a slow progression from onset of symptoms to diagnosis, and caregivers reported a higher prevalence of family history of psychiatric disorders. There were no significant differences in age at onset, duration, female gender, aphasia and apraxia, handedness, family history of Down's syndrome, or number of children, brothers, and sisters. CONCLUSIONS: The association of faster course and family history of psychiatric disorders in the patients with a family history of dementia is consistent with the hypothesis of heterogeneity, but the overall results could also be explained by a genetic-environmental model of Alzheimer's disease.

Age Factors↗
PubMed1992

The ultrasound appearances of intramural bowel gas: the bright ring appearance and the effervescent bowel. A report of three cases.

Bowel necrosis is a serious condition with a very high mortality rate. The earlier the diagnosis is made, the better chance for survival. Ultrasound is a primary imaging technique in the diagnosis of the acute abdomen. Three cases are presented in which bowel wall gas could be demonstrated on ultrasound. In all cases there was computed tomographic and either operative or post-mortem correlation. In each case there was a "bright ring" appearance of the affected bowel when the ultrasound examination was carried out in transverse section. In one case, small bubbles were seen arising from the deep surface of the bowel.

Adult↗
PubMed1992

[Value of sophisticated explorative techniques of the pulmonary function in the preoperative evaluation of respiratory risk].

In order to estimate the preoperative evaluation of the respiratory risk, a well adapted clinical examination associated with a routine pulmonary function test (VC, FEV1) can be sufficient. Although some patients with cardiopulmonary disorders or candidates to lung resection need more complex assessments: the flow-volume loop to detect small airways obstruction (MEF 50%, MEF 25%), measure of bronchial hyperreactivity to predict bronchospasm during anaesthesia, residual volume for the diagnosis of emphysema, diffusing capacity (DCO) to discover lung fibrosis: these parameters disruption always make the pronostic worse. It is also useful to couple together preoperative function test and pulmonary scintigraphy to predict post-operative values after lung resection. But, these criteria for operability are not always a good indicator of post-operative complications. So it is possible to use in addition the results of exercise testing to determine cardio-respiratory performances and maximal oxygen consumption (VO2MAX) which seem better correlated with mortality and post-operative lung surgical complications. Preliminary results of our study concerning thirty patients hospitalized in Besancon-St-Jacques Hospital, agree with the hypothesis that exercise testing is an important criterion in the pre-operative evaluation and to predict post-operative mortality and morbidity of patients candidates to thoracic surgery.

Humans↗
PubMed1992

[Anti-influenza vaccination for active persons (25-64 years): a cost-benefit study].

This paper is a specific cost-benefit study concerning 25-64 years people flu vaccination. For this active population the vaccination rate is only 12% and the cost of absenteeism is potentially high. To make the balance between prevention costs and (direct and indirect) avoided costs by the vaccine, we use a basic case with mean value parameters as: efficacy rate of vaccine, impact of epidemics, size of vaccinated population, immunization length and compensation rate of the so-called production losses. These parameters are then supposed to vary in a sensitivity analysis. In any case net benefit of vaccination appears, which size varies mainly in relation to epidemics and vaccinated population extents. But improvements are to be achieved for giving more precise values to "real" efficacy rate of vaccination and effective economic impact of absenteeism on production.

Absenteeism↗
PubMed1992

Metabolism and aerobic capacity of skeletal muscle in chronic respiratory failure related to chronic obstructive pulmonary disease.

The calf muscle energy metabolism of 8 stable chronic obstructive pulmonary disease (COPD) patients with chronic respiratory failure (arterial oxygen tension (Pao2) 7.7 +/- 0.4 kPa or 58 +/- 3 mmHg) was studied, using 31-phosphorus magnetic resonance spectroscopy (31P MRS). MRS spectra were acquired at rest and during the course of 360 pedal movements at 20, 35 and 50% of the maximal voluntary contraction (MVC) and during recovery. Eight healthy age-matched subjects served as the control group. No significant differences between groups were observed in resting muscle, as regards intracellular pH, Pi/PCr ratio (Pi: inorganic phosphate; PCr: phosphocreatine) and the relative ATP expressed as the ratio beta ATP/PCr + Pi + PME (PME: phosphomonoester). Although effective power outputs were similar for both groups at each work level, COPD patients exhibited a higher Pi/PCr ratio than health controls (3.34 +/- 0.89 vs 0.49 +/- 0.05 at 50% MVC; p less than 0.01) and a lower pHi (6.65 +/- 0.11 vs 7.06 +/- 0.02 at 50% MVC; p less than 0.01). PCr resynthesis during recovery was slower in patients than in control subjects (t1/2 PCr 1.27 +/- 0.26 min vs 0.47 +/- 0.05 min; p less than 0.05). These results suggest impairment of aerobic capacity in a non-ventilatory working muscle, which may be due to hypoxaemia in patients with chronic respiratory failure.

Aged↗
PubMed1991

Influence of mixed chimerism on the results of allogeneic bone marrow transplantation for leukemia.

Serial cytogenetic studies were performed on 60 leukemic recipients of HLA-matched bone marrow transplants (BMT) who were prepared by high doses of alkylating agents and fractionated total body irradiation (TBI). Forty-three patients were recipients of untreated BMT and 17 were recipients of T-depleted BMT. Donor or host mitoses were identified by examination of sex chromosomes in 54 patients or by evaluation of the polymorphism of other chromosomes after specific banding in six patients. Mixed lymphoid chimerism (MLC) was identified in 29 patients and full donor lymphoid chimerism (FDLC) in 29 patients. Complete donor hematopoiesis was recovered in most patients after 12 months, but two T-depleted patients had persistent host cells at 46 and 52 months after the graft. Acute graft-versus-host disease was significantly less frequent in patients with MLC, especially when more than 10% of residual lymphoid cells were detected. The probability of relapse and survival was identical in patients with MLC and FDLC, except in patients with chronic myeloid leukemia where MLC was significantly associated with an increased risk of relapse.

Acute Disease↗
PubMed1991

Impairment of muscular metabolism in chronic respiratory failure. A human 31P MRS study.

The calf muscle metabolism of 7 patients with stable chronic respiratory failure (PaO2 below 65 Torr) was studied using 31P NMR spectroscopy. NMR spectra were acquired at rest, during the course of 360 pedal movements at 20, 35 and 50% of the maximal voluntary contraction (MVC) and during recovery. Eight normal aged-matched subjects served as a control group. In resting muscle, no significant differences were observed between both groups as regards intracellular pH, inorganic phosphate/phosphocreatine (Pi/PCr) and beta-ATP/PCr + Pi + phosphomonoester (PME) ratios. Although effective power outputs were similar for both groups at each work level, patients exhibited a higher Pi/PCr ratio than healthy controls (3.19 +/- 1.01 vs 0.49 +/- 0.05 at 50% MVC; p less than 0.01) and a lower pHi (6.65 +/- 0.11 vs 7.06 +/- 0.02 at 50% MVC; p less than 0.01). Moreover, PCr resynthesis during recovery was slower in patients than in control subjects (t1/2 PCr = 1.26 +/- 0.30 vs 0.47 +/- 0.05 min; p = 0.01). These results suggest impairment of aerobic capacity in a non-ventilatory working muscle, probably due to hypoxemia in patients with chronic respiratory failure.

Adenosine Triphosphate↗
PubMed1991

The long-term outcome of OKT3 compared with cyclosporine prophylaxis after liver transplantation.

We report the long-term follow-up (greater than 1 year) of 46 patients (12 pediatric) randomized to receive OKT3 for the first 14 days after OLT with low-dose steroids compared with 39 patients (8 pediatric) who received cyclosporine, steroids, and azathioprine. The mean period of follow-up for survivors was 648 +/- 261 days for the OKT3 group and 682 +/- 216 days for the cyclosporine group. Of the OKT3 patients, 46% were rejection-free in the first month compared with 31% of CsA-treated patients (P = NS). Rejection occurred after 1 month in 21% of the OKT3 group patients compared with 19% of the CsA group patients. One patient in each group developed vanishing bile duct syndrome. Eight patients in the OKT3 group and 13 in the CsA group experienced steroid-resistant rejection and required OKT3 rescue. In the 8 patients in whom OKT3 was reused, 4 had a positive ELISA after prophylaxis, and in 6, CD3-positive cells were greater than 10% during OKT3 reuse. Five patients resolved the episode. Of patients receiving OKT3 prophylaxis, 39% developed anti-OKT3 antibodies. In the OKT3 group 83% of patients and in the CsA group 75% currently have normal liver function. There was no difference in serum creatinine for either adult or pediatric recipients at 12 months in the two groups. Eight episodes (2 CMV) of severe infection occurred after 1 month in the OKT3 group compared to 11 (4 CMV) in the CsA group. Graft survival, 63% for the OKT3 group and 73% for the CsA group, and patient survival, 67% for the OKT3 group and 84% for the CsA group, were not significantly different in the two groups. We recommend reserving the use of OKT3 for resistant rejection or when cyclosporine is contraindicated, as we can show no long-term benefit from its routine prophylactic use.

Antibodies, Monoclonal↗
PubMed1991

[Does chronic pancreatitis promote duodenal ulcer in men?].

The aims of this study were to assess the prevalence of duodenal ulcer during chronic pancreatitis and the relationship between the occurrence of duodenal ulcer and the course of chronic pancreatitis. The population consisted of 264 men with chronic pancreatitis, 94 percent of which were of alcoholic origin. Duodenal ulcer occurred in 37 patients (14 percent). Fifteen patients with gastric or anastomotic ulcer were excluded. The 37 patients with duodenal ulcer were compared with 212 patients without ulcer. There was no significant difference between the two groups as regards the course of chronic pancreatitis except for insulin-dependent diabetes mellitus which was significantly more frequent in patients without duodenal ulcer (P less than 0.05). Eight patients with duodenal ulcer died but the cause of death was not related to their ulcer. All patients with duodenal ulcer and 92 percent of those without were smokers (not significant). Duodenal ulcer occurred in 25/37 patients (68 percent) before the clinical onset of chronic pancreatitis. The risk of duodenal ulcer occurrence was constant in 17-65 year old patients and independent of the time of chronic pancreatitis onset. We concluded that in men with chronic pancreatitis: a) prevalence of duodenal ulcer is 14 percent; b) duodenal ulcer occurred most often before clinical onset of chronic pancreatitis; c) duodenal ulcer occurs independently of the course of pancreatitis which cannot account for its high prevalence. Smoking may be a promoting factor.

Actuarial Analysis↗
PubMed1991

[Evolution of indications and results of the treatment of alcoholic chronic pancreatitis in men. Study of 222 cases].

The aim of this study was to analyze the evolution of surgical indications in alcoholic chronic pancreatitis (ACP) and to compare long term results after medical (n = 72) and surgical (n = 150) treatment with or without pancreatic resection. Since 1968, a retrospective study was carried out on 222 consecutive male patient. 68% of them, were operated on for unrelieved pain or complications at a mean of 5 years after the onset of the symptom. The mean follow-up was 10 years. The study of evolution of the indications and results of surgical treatment was made on two consecutive ten-year periods and showed that 68% of pancreaticoduodenectomies and 55% of distal pancreatectomies (DP) were performed during the first period. Indications for primary pancreaticoduodenectomy did not decrease since 1980, while those of distal pancreatectomy (DP) changed (no DP for acute pancreatic effusion with fistula before 1980, no DP for unrelieved pain after 1980). Ten patients underwent operative drainage of pseudocysts before 1980 versus 21 after 1980 (13% vs 29%) with no operative death. Twenty patients underwent biliary and/or intestinal and/or ductal drainage during the first period versus 22 during the second (25% vs 30%). The overall 12-year actuarial survival between operated and non operated patients was no significantly different (respectively 72% +/- 10% and 64% +/- 12%). The actuarial 10-year survival rate was significantly better after DP (73% versus 53% after drainage and 28% after pancreaticoduodenectomy). No patients underwent specific pancreatic reoperation after pancreaticoduodenectomy versus 25% after DP.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed1990

The prevalence of dementia and Alzheimer's disease in Shanghai, China: impact of age, gender, and education.

We report the prevalence rates for dementia and Alzheimer's disease (AD) obtained from a probability sample survey of 5,055 noninstitutionalized older persons in Shanghai, China. A two-stage procedure was used for case finding and case identification. A Chinese version of the Mini-Mental State Examination was used to determine cases of possible dementia. Three different cutoff points on this mental status test were used depending on the respondent's level of education. Clinical evaluations, based on functional assessments and psychiatric interview, medical and neurological examinations, three standardized mental status tests, and a selected group of psychometric tests, were made in the second stage of the study to ascertain the clinical diagnosis of dementia and AD utilizing the Diagnostic and Statistical Manual for Mental Disorders, edition 3 and National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association criteria, respectively. The prevalence rate of dementia in persons 65 years and older was 4.6%. Clinically diagnosed AD accounted for 65% of the subjects with dementia. These findings indicate that the prevalence of dementia in Shanghai is very much higher than figures published earlier for China and Japan, and at the lower part of the range of values reported for community residents in the United States and other Western countries, but less than half of that reported in the recently published survey of the elderly in East Boston. Increasing age, gender (female), and low education are each highly significant and independent risk factors for dementia. One hypothesis to explain the increased prevalence in elderly women who had received no formal education invokes the possibility of an effect of early deprivation, perhaps lowering brain "reserve," allowing the symptoms of dementia to appear at an earlier date during disease progression.

Age Factors↗
PubMed1990

Clinical course of spontaneous reactivation of hepatitis B virus infection in patients with chronic hepatitis B.

The purposes of this study were (a) to describe the clinical and biochemical manifestations associated with spontaneous reactivation of hepatitis B virus as defined by the reappearance of hepatitis B virus DNA in serum using dot-blot hybridization and (b) to determine whether the clinical and biochemical manifestations associated with hepatitis B virus reactivation were different in patients with and without human immunodeficiency virus-1 infection. During 1 yr, 110 French patients were admitted to Hôpital Beaujon for chronic hepatitis B. Fourteen were found to have hepatitis B virus reactivation; of these, three were anti-human immunodeficiency virus-1-positive. These 14 patients were HBsAg-positive for 60 mo (range = 6 to 180 mo). Clinical manifestations related to reappearance of hepatitis B virus DNA were present in 11 patients. HBeAg/anti-HBe status did not change in nine patients in whom hepatitis B virus reactivation would not have been recognized without hepatitis B virus DNA testing. Cirrhosis was present in nine patients. Four patients, of whom two were anti-human immunodeficiency virus-1-positive, had fulminant liver failure. Two patients died; one was anti-human immunodeficiency virus-1-positive. One patient was given an emergency transplant.

Adult↗
PubMed1990

Familial Hirschsprung's disease--a report of 22 affected siblings in four families.

Twenty-two infants, belonging to four families from Gaza, presenting with typical features of Hirschsprung's disease are reported. Eight patients died at home shortly after birth, prior to 1974, due to low intestinal obstruction. Fourteen patients were referred to Hadassah University Hospital after 1974 and diagnosed, by rectal biopsy, as having Hirschsprung's disease. Thirteen underwent laparotomy and multiple intestinal biopsies. Ten had total intestinal aganglionosis, two had total or near total aganglionosis, and in only one patient was the common rectosigmoid aganglionosis found. One patient died prior to surgery. This unusual familial disease, involving very long aganglionic segments, raises the possibility that these infants suffered from a unique variant of Hirschsprung's disease.

Family↗