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Biomedical subjects

S Levenstein

Publications and source records attributed to S Levenstein.

At least 37 records · Page 2Linked to original sources
PubMed1994

5-ASA enema versus oral sulphasalazine in maintaining remission in ulcerative colitis.

This prospective trial in patients with left-sided ulcerative colitis evaluated the efficacy and acceptability of biweekly high-dose 5-aminosalicylic acid (5-ASA) enemas (4g/100ml) in maintaining a remission recently induced using daily 5-ASA enemas. Thirty-one patients were randomly assigned, 16 to 5-ASA and 15 to oral sulphasalazine (2g/day), and examined monthly. Sigmoidoscopy was performed "blind" at six months or at clinical relapse. Twelve patients on 5-ASA (75%) and nine on sulphasalazine (60%) remained in clinical and endoscopic remission throughout the study (NS), and the survival curve for 5-ASA was better at all points (NS). No patient stopped therapy due to side effects, and all those on 5-ASA chose to continue rectal maintenance therapy after the study. It was concluded that biweekly 5-ASA enemas is at least as effective as oral sulphasalazine in maintaining remission in unselected patients whose remission has been achieve using local therapy.

Administration, Oral↗
PubMed1994

Psychological stress and disease activity in ulcerative colitis: a multidimensional cross-sectional study.

OBJECTIVES: It is not known whether any link exists between life stress and disease activity in ulcerative colitis; attempts to demonstrate one have been complicated by recall bias, distressing psychological consequences of disease, psychogenic symptom exaggeration, and an irritable bowel component of inflammatory bowel disease symptoms. We therefore studied the relationship between psychological measures and two different aspects of ulcerative colitis activity. METHODS: The relation of perceived stress, depression, state anxiety, trait anxiety, and life events with endoscopic appearance of the rectal mucosa was studied "blind" in 46 asymptomatic outpatients with known ulcerative colitis. The same measures were then examined in relation to subjective activity, comparing the group in clinical remission with 32 ulcerative colitis outpatients who reported symptoms. RESULTS: Among asymptomatic patients, the level of stress over the past 2 yr on the General Perceived Stress Questionnaire was higher in the 11 with mucosal abnormalities than in the 35 with a normal rectal mucosa (p = 0.004). Among the entire population, symptomatic patients were more likely to recall major life events in the previous 6 months than the asymptomatic group (p = .02). Adjustment for smoking and for duration of remission did not substantially alter these findings. CONCLUSIONS: Life stress is associated with both objective and subjective aspects of activity in ulcerative colitis. Although the association of life events with reported symptoms may be subject to recall bias, the association of perceived stress with rectal mucosal abnormalities in asymptomatic patients is strongly suggestive of a true link between psychological factors and ulcerative colitis activity.

Adult↗
PubMed1993

Development of the Perceived Stress Questionnaire: a new tool for psychosomatic research.

A 30-question Perceived Stress Questionnaire (PSQ) was validated, in Italian and English, among 230 subjects. Test-retest reliability was 0.82 for the General (past year or two) PSQ, while monthly Recent (past month) PSQs varied by a mean factor of 1.9 over 6 months; coefficient alpha > 0.9. General and/or Recent PSQ scores were associated with trait anxiety (r = 0.75), Cohen's Perceived Stress Scale (r = 0.73), depression (r = 0.56), self-rated stress (r = 0.56), and stressful life events (p < 0.05). The General PSQ was higher in in-patients than in out-patients (p < 0.05); both forms were correlated with a somatic complaints scale in a non-patient population (r > 0.5), and were higher, among 27 asymptomatic ulcerative colitis patients, in the seven who had rectal inflammation than in those with normal proctoscopy (p = 0.03). Factor analysis yielded seven factors, of which those reflecting interpersonal conflict and tension were significantly associated with health outcomes. The Perceived Stress Questionnaire may be a valuable addition to the armamentarium of psychosomatic researchers.

Adaptation, Psychological↗
PubMed1992

Life events, personality, and physical risk factors in recent-onset duodenal ulcer. A preliminary study.

To clarify the interactions between stressful life events and other risk factors in the development of duodenal ulcer disease, we studied 33 patients with active ulcer, symptomatic for less than or equal to 6 months and untreated during the previous year, using the Paykel Interview for stressful life events, the Minnesota Multiphasic Personality Inventory (MMPI), and Zung's Anxiety and Depression scales. MMPIs were abnormal in 64% of the patients, and 61% showed some degree of depression. The 16 patients whose symptoms had been preceded by severe stress and more pathological MMPIs, especially on paranoia and dependency scales; were more depressed; and had used less nonsteroidal anti-inflammatory drugs than those without (p less than 0.05). They were somewhat more likely to be single, to be of low social class, and to have recently increased use of cigarettes, alcohol, or coffee (though their absolute level of alcohol consumption was low). Anxiety levels did not differ between stress and nonstress groups. Correspondence analysis yielded four clusters of patients, characterized by (a) alcohol/cigarette use, personality disorder, chronicity; (b) early onset, neurosis; (c) depression, life events; (d) late onset, psychosocial stability. The analysis changed little according to whether life events were or were not considered in cluster formation. We conclude that ulcer patients who become ill under stress from a distinct subgroup, that depressed mood and stress-related increases in use of alcohol and cigarettes may mediate between stress and ulcer formation, and that life events are a quantitatively minor factor in ulcerogenesis.

Adult↗
PubMed1989

Crohn's disease and mycobacteria: two cases of Crohn's disease with high anti-mycobacterial antibody levels cured by dapsone therapy.

Five patients with Crohn's colitis or ileocolitis (CD) refractory to conventional therapy were enrolled in an open trial with dapsone (100 mg/day). This therapy was apparently effective in two out of five patients. In these patients we observed a clinical improvement after one month of therapy and, in the first patient, a complete healing of all the cutaneous and rectal ulcers. In the two responders antibody levels to a soluble extract of M. paratuberculosis (MPSE) were significantly greater than in the three non-responders (P = 0.03); in the first patient, moreover, there was a rise of 39% in antibody titres following the treatment. This rise in antibody levels, that might be expected following death of the pathogen and release of antigen, is similar to that observed after treatment of tuberculosis. Our data suggest that a mycobacterial species or another pathogen that cross-react with those of MPSE, sensitive to dapsone, may in a subset of cases be responsible for the development of CD. This is the first report of clinical cure with an agent active against specific bacterial species, associated with immunologic confirmation of a response.

Adult↗
PubMed1987

Prediction of surgery for obstruction in Crohn's ileitis. A study of 64 patients.

The charts of 64 patients with Crohn's ileitis were reviewed to determine what characteristics at the time of first observation at a specialized center were predictive of surgery for irreversible obstruction, using Cox's proportional hazard model. Individual variables which proved significant (P less than 0.01) included age at presentation to the clinic, serum albumin, sedimentation rate, and the presence of radiologic strictures. Patients eventually requiring surgery were older than the rest because of a later date of symptom onset; furthermore, patients with strictures on initial x-rays had not been ill for a longer period of time than those who did not have strictures. These data suggest that fibrosis and stenosis are characteristic of a subgroup of Crohn's patients, rather than being inevitable phases of disease evolution. Multivariate analysis revealed that patients with low serum albumin, high sedimentation rate, and roentgenologic stenosis at first observation were ten times as likely to require surgery for obstruction at 10 years than those without any of these three unfavorable parameters.

Adult↗
PubMed1985

The Balint movement in South Africa. An overview after 10 years.

The background to, initiation of and development of Balint work in the RSA over the past decade is described and discussed. Special reference is made to the establishment of Balint groups in various centres. The formation of the South African Balint Society, its activities and its place in the South African medical scene as well as in the international Balint Federation are also dealt with. Finally, some comments are made regarding the future of the Balint movement in this country.

History, 20th Century↗
PubMed1985

Exaggerated response of thyrotropin to thyrotropin-releasing hormone in patients resected for Crohn's ileitis.

We have studied the response of thyrotropin to exogenous thyrotropin-releasing hormone in 13 patients who had previous intestinal resection for Crohn's disease, and in 42 healthy controls. An exaggerated and prolonged response curve was found in eight of the patients and one control (P less than 0.01), while baseline hormone levels were normal in all. These results may be related to the state of iodine deficiency known to develop in inflammatory bowel disease, but the pathophysiology requires further elucidation.

Adult↗
PubMed1985

Low residue or normal diet in Crohn's disease: a prospective controlled study in Italian patients.

Seventy patients with non-stenosing Crohn's disease were randomly assigned to follow a low residue diet or a normal Italian diet for a mean of 29 months. The two groups were comparable at the onset in various measures of disease severity and diet. Patients complied well with the diet prescriptions, the low residue group eating a mean of 8.1 portions a week of fibre containing foods and the liberalized group a mean of 26.6 portions (p less than 0.005). There was no difference in outcome between the two groups, including symptoms, need for hospitalisation, need for surgery, new complications, nutritional status, or postoperative recurrence. Eighty six per cent of patients eating ad libitum and 65% of patients who avoided roughage eliminated one or more permitted foods because of subjective intolerance. Lifting of dietary restrictions, which results in a more appetizing and nutritious diet, does not cause symptomatic deterioration or precipitate intestinal obstruction in Crohn's disease.

Adult↗
PubMed1984

Student attachment to a general practice in Cape Town. A report of 5 years' experience.

Five years' experience of student attachment to a Cape Town general practice as part of a community medicine 'block' is described. The students found the proceedings valuable and specially mentioned that the holistic approach to patient care, continuing care and the importance of the doctor-patient relationship were issues which they had become aware of for the first time--in sharp contrast to their experience of patient care in the teaching hospital situation. Nearly all the students complained that the time allotted to their attachment and to general practice as a whole was far too short. Various aspects of attachment are discussed, e.g. the doctor's approach, the handling of students' anxieties and the doctor-student relationship. Certain inferences are drawn concerning overall undergraduate medical training.

Attitude↗
PubMed1984

Relationship between clinical and laboratory parameters and length of lesion in Crohn's disease of small bowel.

The correlation of 22 commonly used clinical and laboratory abnormalities with linear extent of the lesion was studied in 70 patients with Crohn's ileitis, 16 of whom had inactive disease and 54 active disease. Extent was measured radiologically using a well-validated double-contrast technique. In the patients with active disease, lesion length was significantly correlated with weight loss, serum albumin, total protein, and serum iron. In the group without active inflammation, pain and abdominal mass were significantly correlated with lesion extent. No correlation was found between linear extent of lesion and the following: an index of inflammatory activity (New Crohn's Disease Activity Index), several acute-phase reactants, and the components of the complete blood count. Only total protein and serum iron had a significant regression coefficient following a procedure of stepwise regression. No mathematical model was found capable of satisfactorily predicting the length of lesion.

Adolescent↗
PubMed1982

An undergraduate Balint group in Cape Town--a follow-up report.

A further year's experience of a Balint group composed of undergraduate medical students (having completed their final year in 1981) and a general practitioner facilitator is reported. The students found that the extra year of participation in the group had increased their understanding of and effectiveness in their relationships with patients. The implications of this experience for undergraduate training are discussed.

Adult↗
PubMed1981

An undergraduate Balint group in Cape Town.

Five months' experience of a Balint group composed of 5th year medical students and a general practitioner facilitator is reported. The students found that the group helped to fill a big gap in their current training, i.e. in the area of the doctor-patient relationship. It is now widely accepted that understanding and skills in the psychological aspects of general practice are of great importance, not only because of the high incidence of such problems but because of the role of psychological factors in physical illness. For example, studies have demonstrated that the single most important factor determining the extent of patient compliance with the doctor's instructions for treatment is the quality of the doctor-patient relationship.

Adolescent↗
PubMed1981

Psychosomatic families and the general practitioner.

'Psychosomatic families' are characterized by 'enmeshment', over-protectiveness, rigidity, and a marked inability to resolve conflicts. A psychosomatically ill child may help the parents to avoid facing the conflicts in their relationship by apparently focusing all their attention on the child. The general practitioner can help such families by utilizing the principles of family therapy.

Adult↗
PubMed1980

The psychological management of the patient with chronic illness and his family.

Chronic illness, whether physical or mental, has a profound psychological effect on the affected individuals and their families. It is necessary for the general practitioner to have a good grasp of these aspects of the care of such patients and their families, not only in order to be of assistance in alleviating the emotional stresses which chronic illness places on them, but also so as to ensure maximal compliance with the treatment regimen of the illness itself. Studies have demonstrated that the most important factor determining patient compliance is the quality of the doctor-patient relationship. Special mention is made of the 'illness solution' in families and the ways in which the general practitioner can deal with this situation.

Adolescent↗