Search PubMed⌕ Search

Biomedical subjects

R Levitt

Publications and source records attributed to R Levitt.

At least 55 records · Page 3Linked to original sources
PubMed1990

A phase II randomized trial of megestrol acetate or dexamethasone in the treatment of hormonally refractory advanced carcinoma of the prostate.

The results of a randomized, multicenter, cooperative group trial evaluating hormonal therapy with either megestrol acetate or dexamethasone in advanced, hormonally refractory prostate cancer are reported. Three of 29 patients (approximately 10%) on the megestrol acetate arm experienced an objective response lasting 41, 84, and 202 days, respectively, whereas two of 29 patients (approximately 7%) on the dexamethasone arm achieved an objective response lasting 359 and 512 days, respectively. Twenty of 29 patients (approximately 69%) on the megestrol acetate arm had stable disease lasting for a median duration of 117 days, whereas 21 of 29 patients (72%) on the dexamethasone arm had stable disease for a median duration of 86 days. Median survival of all patients was 9 months from initiation of treatment. The median survival of all patients on the megestrol acetate arm was 268 days compared to 246 days for patients on the dexamethasone arm (P = 0.2). Neither dexamethasone nor megestrol acetate would seem to be of substantive value in altering the progression of advanced, hormonally refractory prostate cancer.

Aged↗
PubMed1989

Effect of time and dose on scalp-recorded somatosensory evoked potential wave augmentation by etomidate.

Bolus etomidate transiently increases the amplitude of scalprecorded somatosensory evoked potentials (SSEPs). The reproducibility of this augmentation and its dose-response relationship are unknown. In unpremedicated patients, we studied the effect on the SSEP of repetitive administration of single doses of etomidate (0.1 mg/kg i.v. bolus) in six patients and increasing doses of etomidate in six additional patients. Anesthesia was induced with fentanyl (15-20 microg/kg i.v.) plus thiopental (1-2 mg/kg i.v.) and maintannined with 0.4-0.8% isoflurane in oxygen, and the surgical incision was infiltrated with bupivicaine (0.5% without epinephrine). Etomidate administration was delayed for 30 min following anesthesia induction. In group 1, 0.1 mg/kg etomidate was administered intravenously as a bolus three times at 30-min intervals. In group 2, 0.05, 0.1, or 0.2 mg/kg was administered at 30-min intervals in random order in each patient. SSEPs were measured immediately before and once each minute for 5 min after etomidate administration following nondominant median nerve stimulation. In group 1, administration of 0.1 mg/kg etomidate (three trials) increased latency of an early negative wave (N20; latency approximately 20 ms) and a positive wave following N20 (P23; latency approximately 23 ms) by 1.0-1.4 and 1.3-2.6 ms, respectively (p < 0.05). P15N20 amplitude was increased by approximately 50% (range 36-76%; p < 0.05) and N20P23 amplitude was increased to 174% of control (range 173-178%; p < 0.05) and the amplitude increase was similar during the three etomidate administrations for both P15N20 and N20P23. Latency remained elevated by approximately 1.5 ms and amplitude remained elevated (P15N20 = 138%; N20P23 = 150%) 5 min following injection. Mean arterial blood pressure was unchanged by 0.1 mg/kg etomidate. In group 2, 0.05 mg/kg etomidate altered neither amplitude nor latency. However, 0.1 and 0.2 mg/kg increased N20P23 amplitude to 161 +/- 33 and 230 +/- 10% of control (p < 0.05), respectively. N20 and P23 latency were increased by 0.1 mg/kg etomidate by approximately 1.0 ms, while 0.2 mg/kg increased N20 latency by 1.0 ms and P23 latency by 1.5 ms. Bolus administration of etomidate (0.1 mg/kg) reproducibly increased SSEP amplitude and a larger dose (0.2 mg/kg) further increased amplitude augmentation. Thus, intermittent injection of etomidate can be used to augment small SSEP waves with reproducible increases in wave amplitude.

Journal Article↗
PubMed1989

Foramen magnum decompression in an infant with homozygous achondroplasia. Case report.

Homozygous achondroplasia is a rare yet distinct clinical entity. Most infants succumb to an early death as a result of respiratory compromise due to upper airway obstruction, thoracic cage deformity, and/or cervicomedullary compression. The successful cervicomedullary decompression of a 16-week-old infant with homozygous achondroplasia is described. This report suggests that homozygous achondroplasia is not universally fatal and that these infants are potentially viable if managed by aggressive respiratory and surgical measures.

Achondroplasia↗
PubMed1986

Phase I-II trial of VP-16 in the treatment of acute nonlymphocytic leukemia and blast crisis of chronic granulocytic leukemia.

VP-16 was used to treat newly diagnosed elderly (greater than or equal to 65 yr) patients with acute nonlymphocytic leukemia (ANLL) and patients with blast crisis of chronic granulocytic leukemia (BI-CGL). Our pilot study indicated that VP-16 160 mg/m2 intravenously daily for 5 days was well tolerated and suggested a direct dose-response correlation. Thirty additional ANLL patients and 11 CGL patients were studied. Among 26 evaluable ANLL patients, we observed ten responses (38%) (seven complete remission and three partial remission), but none of 11 patients with CGL in blast crisis had meaningful responses. In patients who responded to treatment, myelosuppression was always reversed by day 25. Stomatitis was the major nonhematologic toxicity and appeared more severe with advancing age. We conclude that VP-16 is active against ANLL and is well tolerated at doses higher than have been previously described. It remains to be shown that the present schedule is superior to the intermittent high-dose or continuous low-dose infusion schedules, which have been recently described.

Adult↗
PubMed1984

Abdominal wall endometrioma: CT findings.

Endometriosis of the superficial soft tissues is an uncommon lesion that may occur in the absence of other evidence of pelvic endometriosis. An example of an endometrioma arising in the rectus sheath is reported here. To our knowledge, this is the first CT description of an anterior abdominal wall endometrioma.

Abdominal Muscles↗
PubMed1984

Cefotaxime compared with nafcillin plus tobramycin for serious bacterial infections. A randomized, double-blind trial.

In a prospective, randomized, double-blind study, we compared cefotaxime with nafcillin plus tobramycin in the treatment of serious bacterial infections. Of 195 patients with suspected or proven infections who were not neutropenic, definite bacterial infections were identified in 81; 34 of 38 patients given cefotaxime and 26 of 43 given nafcillin plus tobramycin (p less than 0.01) responded to treatment. The difference in response rates occurred primarily in patients with rapidly fatal underlying disease or with an infection outside the urinary tract. A logistic regression analysis showed that treatment with cefotaxime was still associated with a higher response rate after adjusting for several potential confounding factors. Among patients treated for 3 days or more, our criteria for nephrotoxicity were met in 2 of 68 (2.9%) given cefotaxime and 16 of 57 (28.1%) given nafcillin plus tobramycin (p less than 0.001). Prolongation of the prothrombin time and enterococcal colonization did not occur more frequently with cefotaxime. We conclude that cefotaxime may be more effective and less toxic than nafcillin plus tobramycin for patients with serious bacterial infections.

Adult↗
PubMed1980

Malignant histiocytosis as a terminal condition in chronic lymphocytic leukemia.

Chronic lymphocytic leukemia rarely develops an acute blastic phase as a terminal complication. When it does, the blastic phase is characterized by the appearance of large, immature cells with the same immunologic markers as the cells in the chronic phase of chronic lymphocytic leukemia; this coexistence of mature lymphocytes and blastic forms in chronic lymphocytic leukemia has been termed "Richter's syndrome." In a patient of ours with chronic lymphocytic leukemia, the development of a presumed large cell lymphoma was recognized on both bone marrow aspiration and biopsy examination, but later the condition was proved to be a true histiocytic neoplasm (malignant histiocytosis) by cytochemical and immunohistochemical techniques. We are unaware of another reported instance of malignant histiocytosis as a terminal complication of chronic lymphocytic leukemia and mimicking Richter's syndrome.

Aged↗
PubMed1978

Gathering new ideas.

Explore the source record for details and available documents.

Regional Health Planning↗
PubMed1978

Atypical lymphoid leukemia in ataxia telangiectasia.

We observed two sisters with ataxia telangiectasia, one of whom developed an atypical subacute lymphocytic leukemia characterized by atypical lymphocytes and absence of palpable lymphadenopathy or hepatosplenomegaly. The lack of organomegaly in this patient may have been due to the underlying ataxia telangiectasia, which was associated with lymphoid hypoplasia. Cytogenetic studies showed a marker chromosome 14 [t(14q11:14q34)] in both patients. The sister with leukemia had other complex chromosomal aberrations in addition to the marker chromosome 14 that were stable for more than 14 mo before the patient's death from complicating infection. The development of atypical T cell leukemia has not been previously described in ataxia telangiectasia. This case further illustrates the interesting interrelationships amoung immunosuppressed states, development of lymphoid malignancy, and an emerging pattern of a propensity to chromosome 14 abnormalities in various lymphoid malignancies.

Ataxia Telangiectasia↗
PubMed1978

The teaching of human sexuality in a family medicine training program.

Sexual health is an important component of the individual's total health picture. The primary physician, however, is often ill-prepared to deal with issues around sexuality and sexual dysfunction, and family medicine units need to structure programs for teaching in this area. This article describes a teaching program on human sexuality in a family medicine setting. Its major goals were the transmission of information, the teaching of skills, and the desensitization of the health care professional in this area. The program consisted of a series of four seminars and ongoing teaching. The seminars focused on the human sexual response, sexual myths, sexual history taking, and sexual dysfunction and treatment. Ongoing teaching included case discussion, consultation, and joint interviews. It is hoped that the description of this program will serve as a model and/or impetus to other family medicine training programs.

Family Practice↗