Biomedical subjects
Y Levo
Publications and source records attributed to Y Levo.
Shigellosis in adults: epidemiologic, clinical, and laboratory features.
One hundred and sixteen cases of adult patients hospitalized for shigellosis have been reviewed. The most common presentation included diarrhea (most frequently watery), fever, and abdominal pain, while dysentery has been less frequent. S. flexneri infection, as compared to S. sonnei, was more common in elderly patients and in males, and was characterized by a more prolonged clinical course. Abnormalities of serum electrolytes and hepatic enzymes were the most common laboratory complications, most often seen in elderly patients. Most isolates exhibited susceptibility to the common antimicrobial agents used in shigellosis therapy.
Recombinant interferon alpha-C for advanced hairy cell leukemia. An Israeli multicenter study.
Thirteen patients with advanced hairy cell leukemia were treated with a new subspecies of interferon (IFN): recombinant IFN (rIFN)-alpha-C. The timing of the peripheral hematologic remission of individual blood elements was similar to that reported for other interferons, and 60% of patients attained a complete peripheral hematologic remission at 9 months. Two patients relapsed despite a good initial response to IFN. No anti-IFN antibodies could be detected in their sera. In vitro studies of colony formation from the peripheral blood of all responding patients showed that rIFN-alpha-C did not inhibit the growth of colonies but favorably affected the maturation of their elements towards monocytes, granulocytes, and erythroid elements. The relapsing patient examined initially experienced a similar beneficial in vitro response which paralleled his in vivo improvement. During relapse, rIFN-alpha-C inhibited both the colony formation and the myelomonocytic differentiation in the in vitro cultures. These findings may suggest that the acquired resistance to IFN in our patient could be due either to an acquired stem cell maturation arrest in response to IFN or to emergence of a new clone indifferent to IFN-alpha-C differentiation effect.
[Fulminant hepatitis in Wilson's disease--diagnostic and therapeutic problems].
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Amylase-creatinine clearance ratio. A simple test to predict gentamicin nephrotoxicity.
The initial target of aminoglycoside nephrotoxicity is the proximal tubule. Yet, no simple test is available to predict such toxicity. Taking advantage of the fact that amylase is filtered in the glomerulus and reabsorbed by the proximal tubules, we prospectively examined in 23 patients if changes in renal amylase creatinine clearance ratio (ACCR) can predict gentamicin nephrotoxicity. Eighteen of these patients had an initial creatinine clearance (rCcr) above 30 mL/min. Eleven of them (group A) had an ACCR above 3.5% (control 3% +/- 1.03%) and all exhibited an average reduction of 32.2% +/- 11.6% in rCcr following one week of gentamicin therapy. In contrast, only one of seven patients (group B) with an initial ACCR below 3.5% had a reduction, albeit transient, in rCcr. During gentamicin therapy, group A patients had a further increase in ACCR which was proportional to the reduction observed in rCcr (r = -.54). Our preliminary data suggest that ACCR may prove a simple and possibly a reliable predictor of kidney function deterioration during gentamicin therapy in patients with rCcr above 30 mL/min: patients with pretherapy ACCR above 3.5% may exhibit a deterioration in the creatinine clearance during the first week of therapy. For patients with pretherapy renal failure (rCcr less than 30 mL/min) the creatinine levels (but not the ACCR) seem to retain their significance in predicting and monitoring further renal function deterioration during aminoglycoside therapy.
Does tumor necrosis factor play a role in the pathogenesis of fulminant hepatitis?
Fulminant hepatitis is associated with an 80% mortality rate. Surviving patients do not develop chronic liver disease. Failure to produce adequate amounts of interferon and to achieve an antiviral state seem to be the basic defects in this condition. Tumor necrosis factor (TNF) has been shown to be induced by viruses. By rapid lysis of virus infected cells, it also prevents optimal viral replication thus reducing the viral yield and the infection rate and extent. On the other hand, it has growth promoting characteristics. We postulate that TNF has a dual role in fulminant hepatitis: (a) It acts as an antiviral agent by eliminating virus infected cells thus reducing viral yields and limiting spread of infection; (b) it may be the signal for hepatocyte regeneration. Only those patients, in whom the regeneration rate exceeds lysis of infected hepatocyte by TNF, survive.
Severe congestive lupus cardiomyopathy complicated by an intracavitary thrombus: a clinical and echocardiographic followup.
Severe congestive cardiomyopathy is an uncommon complication of systemic lupus erythematosus (SLE). We describe a patient with active SLE and a circulating anticoagulant. She presented with a rapidly progressive cardiomyopathy, complicated by an intracavitary thrombus and cerebral infarction. The course of the disease is described, with special emphasis on the usefulness of consecutive echocardiographic studies.
Fulminant Wilsonian hepatitis: difficulties in diagnosis and treatment.
We present herein the case of a 16-yr-old girl with fulminant Wilsonian hepatitis. Complications included renal tubular damage, hemolysis, marked hypocomplementemia and hypergammaglobulinemia, spontaneous bacterial peritonitis, and Candida sepsis. The difficulties in diagnosis and treatment are discussed.
Reduced production of tumor necrosis factor by mononuclear cells in hairy cell leukemia patients and improvement following interferon therapy.
In 16 patients with hairy cell leukemia (HCL) there was a marked reduction in the production of cytotoxins (CTXs) by peripheral blood mononuclear leukocytes in response to stimulation in vitro by phytohemagglutinin (PHA), 4 beta-phorbol-12-myristate-13-acetate (PMA), or Sendai virus. CTX yields of 23.5 +/- 21.5 U/ml, 15 +/- 18 U/ml, and 12.1 +/- 12.1 U/ml were obtained in response to PHA, PMA, and Sendai virus, respectively, as compared with corresponding yields of 207.3 +/- 93.1, 154 +/- 37.4, and 205.2 +/- 62.4 in healthy controls. The extent of reduced production of CTXs appeared to be correlated with the severity of the disease. Systemic interferon (IFN) administered to four patients caused CTX production to improve in response to PHA (147.5 +/- 55.1 U/ml compared with pretreatment values of 14.1 +/- 6 U/ml, P less than 0.05). However, CTX production in response to Sendai virus remained low. The extent to which CTX production by hairy cell leukemia mononuclear cells was reduced was proportionate to the observed decrease in monocyte counts. However, the degree to which CTX production improved after IFN treatment was significantly greater than the observed increase in monocyte counts. The major CTX induced by PHA in mononuclear cells of healthy donors and of IFN-treated HCL patients was identified as tumor necrosis factor-alpha.
[Tumor necrosis factor].
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[Tubulo-interstitial involvement of the kidney in systemic lupus erythematosus].
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Bacteremic hypocalcemia. A comparison between the calcium levels of bacteremic and nonbacteremic patients with infection.
Hypocalcemia has been documented in critically ill patients, including those with sepsis and shock. However, its incidence and significance in bacteremic patients without shock has not been established. In the present study the presence of hypocalcemia was evaluated in a group of 67 consecutive bacteremic patients, as compared with 64 infected but nonbacteremic patients. After correction of serum calcium level for serum protein, 25 of the bacteremic patients (37.3%) had "corrected" hypocalcemia (less than 8.5 mg/dL [2.12 mmol/L]), compared with only three in the nonbacteremic group (4.5%). The incidence and magnitude of hypocalcemia in gram-positive and gram-negative infections was similar. In hypocalcemic patients, the "corrected" calcium level was found to be inversely correlated with day of disease and attained a nadir on day 6 to 8 of bacteremia. This nadir was significantly lower in male than in female subjects. Hypocalcemic patients had a significantly higher maximal temperature than normocalcemic ones, but hypocalcemia was unrelated to serum levels of albumin, transaminase, and creatinine.
Right ventricular thrombus and pulmonary emboli in a patient with emphysema: an echocardiographic and Doppler documentation.
Pulmonary hypertension is a known complication of chronic obstructive pulmonary disease (COPD). A worsening dyspnea in a patient with COPD is usually a sequela of the pulmonary disease. However, it may be due to pulmonary embolism, a complication which is difficult to diagnose in such patients. We present a patient with COPD in whom two-dimensional and Doppler echocardiography confirmed the diagnosis of pulmonary emboli by documenting right ventricular thrombus and pulmonary hypertension. This case report emphasizes the usefulness of these noninvasive cardiac imaging techniques in the detection and evaluation of pulmonary embolism in patients with COPD.
Computer-aided information system to support direct patient care. The application of a hand-held data collector in a department of medicine.
In the pilot study, described herein, we have tried to develop a computerized system to assist and improve medical and nursing care. Our major goal was to bring the computer to the patient's bedside. This was achieved by a Hand-Held Data Collector, which is easy to carry and operate, and has a big enough memory. In this preliminary study, we have developed appropriate software specifically designed to reflect the daily activities and needs of a department of medicine. Using this software, we have demonstrated that all 'clinical events' and routine tasks of the department can be managed via the Hand-Held Data Collector.
Lupus anticoagulant, thrombosis and thrombocytopenia in systemic lupus erythematosus.
Thirty-six patients were studied for the presence of the lupus anticoagulant and its possible clinical and laboratory associations. Seven patients were found to have the anticoagulant. These patients had a significantly increased incidence of both thromboembolic complications (5/7 vs. 2/29) and thrombocytopenia (4/7 vs. 4/29). None of them had a bleeding tendency. Except for these associations, patients with the anticoagulant did not differ from those without the anticoagulant by any demographic, clinical, or laboratory parameter. The present study confirms observations that SLE patients with the lupus anticoagulant have an increased risk of thrombosis.
A benign course of multicentric Castleman's disease with involvement of the spleen and bone marrow.
The multicentric variant of Castleman's disease (MCCD) is associated with a rapidly progressive and fatal course. The case described herein manifested unique clinical and histological features. Initial presentation as isolated splenomegaly was subsequently followed by widespread organ involvement, including lymph nodes and bone marrow. In spite of this, the patient had a very benign course of her disease. The case serves to expand even further the already wide clinical spectrum of Castleman's disease.
[The pathophysiologic and therapeutic significance of circulating anticoagulants in SLE].
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