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Biomedical subjects

S J Levine

Publications and source records attributed to S J Levine.

28 records · Page 2Linked to original sources
PubMed1992

Diagnosis of Pneumocystis carinii pneumonia by multiple lobe, site-directed bronchoalveolar lavage with immunofluorescent monoclonal antibody staining in human immunodeficiency virus-infected patients receiving aerosolized pentamidine chemoprophylaxis.

The yields of both induced sputum examination and bronchoalveolar lavage (BAL) have been reported to be decreased for breakthrough episodes of Pneumocystis carinii pneumonia in human immunodeficiency virus-infected patients receiving aerosolized pentamidine chemoprophylaxis. This study assessed whether the yield of a single middle or lower lobe BAL could be increased by the utilization of two techniques: (1) indirect immunofluorescent staining with a combination of two murine monoclonal anti-Pneumocystis antibodies in addition to routine toluidine blue O and cytopathologic staining, and (2) the performance of multiple lobe, site-directed BAL (i.e., both upper lobe and middle or lower lobe lavage, including the lobe with the greatest radiographic abnormality). Results of 252 fiberoptic bronchoscopies performed at the National Institutes of Health and the Los Angeles County-University of Southern California Medical Center were analyzed. P. carinii pneumonia was documented in 21 episodes in patients who did not receive prior anti-Pneumocystis chemoprophylaxis and in 41 episodes in patients who received aerosolized pentamidine. Monoclonal antibody staining and multiple lobe, site-directed BAL resulted in similar diagnostic yields for P. carinii in the nonprophylaxis (100%) and aerosolized pentamidine (98%) groups. If BAL had been performed without monoclonal antibody staining and multiple lobe, site-directed lavage, then the yield would have decreased to 95% in the nonprophylaxis group and to 80% in the aerosolized pentamidine group.(ABSTRACT TRUNCATED AT 250 WORDS)

AIDS-Related Opportunistic Infections↗
PubMed1992

An approach to the diagnosis of pulmonary infections in immunosuppressed patients.

The goal of this review is to provide an approach to the diagnosis of pulmonary infections in immunosuppressed patients. First, a framework will be provided to narrow the extensive list of possible infectious and noninfectious pulmonary complications. This can be accomplished by considering the underlying immune defect, the pattern of radiographic presentation, the rapidity of progression of radiographic infiltrates, the typical temporal pattern of infection in specific disease states, and the local epidemiology at one's institution. Next, the yields and potential complications of invasive and noninvasive diagnostic techniques for pulmonary infections are reviewed. Lastly, algorithms, which account for the pattern of radiographic presentation, the primary disease and its underlying immune defect and the anticipated yields and complications of diagnostic procedures, are provided as a suggested plan for the use of diagnostic techniques and the institution of therapy.

Algorithms↗
PubMed1991

Effect of aerosolized pentamidine prophylaxis on the diagnosis of Pneumocystis carinii pneumonia by induced sputum examination in patients infected with the human immunodeficiency virus.

This study assessed the effect of aerosolized pentamidine prophylaxis on the clinical presentation and diagnostic sensitivity of induced sputum examination for Pneumocystis carinii pneumonia. Between January 1, 1988 and October 27, 1990, 348 induced sputum examinations were performed as the initial diagnostic procedure for P. carinii pneumonia in patients infected with the human immunodeficiency virus (HIV). Medical records were reviewed for all induced sputum examinations, and the study group consisted of patients who either had not received prophylactic therapy (n = 193) or had received aerosolized pentamidine prophylaxis (n = 126). A total of 29 induced sputum examinations in patients receiving either other prophylactic regimens or ongoing therapy for previously documented P. carinii pneumonia were excluded from the study group. A total of 72 consecutive episodes of P. carinii pneumonia were subsequently documented by induced sputum examination (n = 54), bronchoalveolar lavage (n = 16), thoracocentesis (n = 1), or autopsy (n = 1). A total of 44 episodes occurred in patients who had not received antipneumocystis prophylaxis, and 28 episodes occurred in patients who had received aerosolized pentamidine. Of patients capable of producing a sputum specimen for analysis, induced sputum examination had a significantly lower diagnostic yield of 64.3% in patients who had received aerosolized pentamidine prophylaxis compared with 92.3% in patients who did not receive prophylaxis (p less than 0.02, Fisher's exact test). When the data were analyzed on an intention to treat basis, although there was a trend suggesting a lower overall yield in the aerosolized pentamidine patients, the difference was not statistically significant (64.3 versus 81.8%, p = 0.17, Fisher's exact test).(ABSTRACT TRUNCATED AT 250 WORDS)

Aerosols↗
PubMed1990

The incidence and significance of Staphylococcus aureus in respiratory cultures from patients infected with the human immunodeficiency virus.

This study assessed the incidence and clinical significance of recovery of Staphylococcus aureus from the respiratory tract of patients infected with the human immunodeficiency virus (HIV). In a retrospective review of 129 consecutive episodes of respiratory disease in HIV-seropositive patients where respiratory tract cultures were obtained, S. aureus was recovered in 30 (23%) of the episodes. Twenty-nine of these were evaluated in this study, and the recovery of S. aureus was found to represent pneumonia in 8 cases (28%), to be of indeterminate significance in 18 cases (62%), and to represent colonization in 3 cases (10%). Episodes of S. aureus pneumonia were usually community-acquired (seven of eight episodes) and had an acute or subacute clinical presentation. Fever and physical signs of pneumonia were present in all patients. Chest radiographic presentations varied, but local infiltrates were seen in seven of eight episodes. Concomitant pulmonary disorders were common (seven of eight episodes). All patients were appropriately treated; five patients recovered and three died, giving a mortality rate of 38%. We conclude that S. aureus is a frequent isolate from respiratory tract cultures of HIV-seropositive patients referred for evaluation of pulmonary disease. It can cause a pneumonia with a high mortality rate, as it did in 6% of all episodes of pulmonary disease reviewed in this study. Clinicians should be aware that HIV-seropositive patients may develop respiratory disease secondary to S. aureus infection and that when this organism is suspected, appropriate antibiotic therapy should be instituted.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Pneumocystis carinii.

This article covers the biology, epidemiology, and pathology of infection with Pneumocystis carinii. The clinical presentation, course, and treatment of pneumonia caused by this organism in patients infected with the human immunodeficiency virus is discussed.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Blood donation by the elderly. Clinical and policy considerations.

At present, healthy potential blood donors older than the age of 66 years often leave the donor pool for reasons of age alone, despite the fact that this demographic group is growing, is a potentially willing source of blood products, and constitutes the cohort with highest per capita use of blood and its derivatives. There is no clinical or physiological rationale for this. We performed a controlled study to measure the feasibility and safety of blood donation by healthy elderly donors aged 66 years and older, compared with a younger cohort aged 55 to 65 years of age. A study group of prior donors aged 66 years and older and a control group of prior donors between the ages of 50 and 65 were sent letters inviting them to donate blood. The volume donated did not differ between the two groups. In the older group, there were eight immediate reactions, seven mild and one moderate. The control population experienced seven immediate reactions, six mild and one severe. We conclude that it is both clinically feasible and efficient to recruit healthy prior donors older than the age of 66 years for blood donation. As a group, this population is potentially able to donate large volumes of blood and do so without any difference in immediate or short-term reactions. Further study of hemodynamic variables as more objective markers of safety is needed.

Adult↗
PubMed1983

Detection of platelet antibodies using the platelet migration inhibition assay.

We evaluated the usefulness of the Platelet Migration Inhibition (PMI) assay in detecting antibody to platelets in patients receiving platelet transfusions. Forty-one PMI assays were performed on pretransfusion sera from 19 patients. After each transfusion, each patient was evaluated clinically and by transfusion response for alloimmunization. Prevalence of antiplatelet antibody, the predictive value of positive and negative results, and efficiency of the PMI assay were calculated. The 41 PMI assays yielded true-positive, true-negative, false-positive, and false-negative results of 18, 14, 5, and 4, respectively. The sensitivity and specificity of the PMI assay were calculated at 81.8% and 73.7%. The PMI assay was comparable in sensitivity and specificity to immunofluorescence and superior to platelet aggregation and lymphocytotoxicity for detecting platelet (inhibition) antibodies. This test is simple and less costly than immunofluorescence; however, it lacks speed and efficiency for crossmatching purposes. It is useful as a clinical test in screening potential platelet pheresis donors and patients receiving platelet transfusions every other day. It may prove useful in research as a functional test to understand alloimmunization and restricted alloimmunization.

Blood Platelets↗
PubMed1982

Antigens of human pancreatic adenocarcinoma cells defined by murine monoclonal antibodies.

We have elicited and characterized the serological specificity of five murine monoclonal antibodies (DU-PAN-1, 2, 3, 4, and 5) to a human pancreatic tumor cell line, HPAF. The antibodies are not detecting HLA-associated antigens since all of the monoclonals failed to react with human lymphoid and myeloid cell lines and uncultured cells. All of the monoclonals except DU-PAN-5 reacted with four of five pancreatic tumor cell lines and two of two uncultured pancreatic tumors. An immunoperoxidase technique was used to determine the presence of the antigens detected by the monoclonal antibodies in frozen sections of tumor and adult and fetal normal tissues. DU-PAN-1 antigen was detected on pancreatic tumors, and a transitional cell carcinoma of the bladder, but was detected on no other adult or fetal normal tissues including pancreas. One of the antigens (DU-PAN-2) defined by the monoclonals was present on pancreatic ductal epithelial cells and showed a restricted distribution on tumor cells from some other carcinoma patients and on cells from certain fetal tissues. DU-PAN-3 antigen was present on adult and fetal pancreatic cells and certain tumor cells but could not be detected on cells of other fetal or adult normal tissues. DU-PAN-4 and DU-PAN-5 antigens have a more widespread distribution on normal or tumor cell types.

Adenocarcinoma↗