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Biomedical subjects

A B Levin

Publications and source records attributed to A B Levin.

At least 37 records · Page 2Linked to original sources
PubMed1983

The use of stereotaxic chemical hypophysectomy in the treatment of thalamic pain syndrome.

Three patients with neurological injuries consistent with cerebral stroke subsequently developed pain over portions of the body contralateral to the injured hemisphere. Stereotaxic chemical hypophysectomy was used in the management of this pain after other surgical procedures and medical management had failed to provide relief. Postoperatively, all patients were treated for hypopituitarism. All developed transient diabetes insipidus, and one patient developed transient right third nerve palsy. No other complications were encountered. All three patients experienced significant pain relief within 48 hours of the procedure. By the date of discharge, two of the three patients reported complete, and the third greater than 80% pain relief. At the initial follow-up visit all patients were essentially pain-free. These patients have now been followed for 58, 39 and 19 months, and remain free of their original pain. During this time the intravenous administration of naloxone has failed to reproduce the preoperative pain. Pituitary function testing 1 year or more following operation demonstrated that none of the patients had an endocrinologically complete hypophysectomy. Recovery from transient diabetes insipidus was not associated with return of the original pain. The mechanism of action of stereotaxic chemical hypophysectomy in the relief of pain related to thalamic lesions remains unknown. The observation that naloxone failed to reproduce the preoperative pain casts doubt on the theory that augmentation of endogenous opiate release is the primary mechanism. Additional observations suggest that pain relief after hypophysectomy may be more directly the result of stimulation of a hypothalamic pain-suppressing mechanism than due to the elimination of pituitary hormones.

Aged↗
PubMed1982

Oxygen saturation during sleep in patients with spinal cord injury.

Sleep is associated with moderate or severe arterial desaturation in many disease states. This study was undertaken to evaluate whether hypoxemia during sleep was a significant problem in the spinal cord injured patient. Eleven patients with cervical or thoracic cord injury who had significant respiratory deficiency were evaluated. The mean age was 29.2 +/- 14. Vital capacity (VC) for the group revealed a mean of 43.1 +/- 18.1% of predicted, inspiratory capacity (IC) was 51.6 +/- 20.2% of predicted, and expiratory reserve volume (ERV) was 23.6 +/- 24.7% of predicted. In eight patients blood gases revealed a mean PO2 of 81.5 +/- 8.4 mmHg and PCO2 of 38.9 +/- 3.4 mmHg. Sleep screening studies were done using the Hewlett-Packard ear oximeter. They were studied for a mean of 2.6 +/- 1.1 hours. The initial O2 saturation was 96.6 +/- 1.6% and dropped to a mean of 90.6 +/- 6.4%. Only 1/11 reached saturation to less than 85% and 2/11 reached levels lower than 90%. Only age was significantly correlated with amount of desaturation (p less than .01). The level of the lesion, and % predicted ERV were not. One of the two patients who had hypoxemia with sleep had unilateral diaphragmatic paralysis. It is concluded that young quadriplegic patients with normal diaphragmatic function have no severe desaturation during sleep, but older patients and patients with some diaphragmatic dysfunction should be screened for sleep desaturation.

Adolescent↗
PubMed1981

Effect of prophylactic methicillin on cerebrospinal fluid shunt infections in children.

This study retrospectively and prospectively analyzes uncomplicated, noninfected, primary ventriculoperitoneal shunting procedures and ventriculoperitoneal shunt revisions in children done at the University of Wisconsin Hospital from July 1973 to December 1979. We compared the infection rates between patients whose procedures were done without prophylactic antibiotics and those who received prophylactic single dose methicillin at the time of operation. Among 105 procedures done without prophylactic methicillin, there were 8 infections; 4 occurred after 73 primary shunt placements and 4 followed 32 shunt revisions. Among 66 procedures done with prophylactic methicillin, there were 3 infections; all followed primary shunt insertions. There was no infection after 32 shunt revisions in which prophylactic antibiotics were used.

Adolescent↗
PubMed1981

Nonsurgical management of spontaneous intracerebral hematoma.

This report describes our experience with the use of osmotic diuretics, governed by continuous monitoring of intracranial pressure (ICP), as the primary treatment for 12 consecutive patients suffering from an acute, supratentorial intracerebral hematoma. In all cases the hematoma, as shown by computed tomographic scan, had a long axis of greater than 4.0 cm. ICP and cerebral perfusion pressure were successfully maintained within the assigned limits in all patients, and in none was surgical evacuation required. There was one death during the 6-month follow-up period. With appropriate weighting to differences in admission status, statistical comparison of the patient outcome in the present series with that reported by McKissock et al. suggests that ICP monitoring can improve the outcome of conservatively (and perhaps surgically) treated patients.

Adolescent↗
PubMed1980

Brain metabolism after 30 minutes of hypoxic or anoxic perfusion or ischemia.

In 48 separate experiments, isolated canine brain preparations were subjected to 30 min of either hypoxic (PaO2 congruent to 20 mmHg) perfusion, anoxic (PaO2 < 10 mmHg) perfusion, or total ischemia followed by reperfusion for up to 2 h with normal oxygenated blood. Unlike ischemia and anoxia, energy metabolism was sufficient during hypoxia to maintain substantial levels of ATP (48% of normal), sustain normal ion gradients, and prevent edema formation. Posthypoxia metabolism was adequate to clear accumulated lactate, enable recovery of normal tissue glucose levels, and allow return to normal levels of glycolytic intermediates. Although not as complete as that following hypoxia, recovery from cerebral edema and restoration of metabolism were better in ischemic than anoxic cortex. The reduced oxygen uptake in all groups during reoxygenation (55% of normal) indicates that all have a diminished capacity for energy metabolism. The ATP levels recovered more rapidly after 15 min of reoxygenation in the anoxic (57% of normal) than in the ischemic (21% of normal) group. Thus ATP does not appear to be directly related to recovery from edema.

Adenosine Triphosphate↗
PubMed1980

Treatment of pain of diffuse metastatic cancer by stereotactic chemical hypophysectomy: long term results and observations on mechanism of action.

Stereotactic instillation of absolute alcohol into the sella turcica for pituitary destruction was carried out in 29 patients divided into two groups. Seventeen with prostatic carcinoma underwent a total of 19 injections with 94% good to excellent results that persisted throughout the remainder of the patient's life-span. The longest survival was 9 months. Brief relapses did occur, but spontaneous remissions were the rule. A second group of mixed cancers contained 12 patients who received a total of 13 injections. Eleven patients had good to excellent results that persisted in all but 1 patient. The longest survival was 7 months. Hormonal levels and prolactin stimulation tests failed to show any correlation between hormonal changes and pain relief. Naloxone reversal of analgesia did not occur. There was no loss of cognitive function shown on psychological testing. Pathological studies showed destruction of the pituitary gland, which was subtotal in some patients despite good pain relief. All examinations showed that the pituitary stalk was destroyed. Patients who survived longer also showed degeneration of the supraoptic and paraventricular nuclei of the hypothalamus and the median eminence. All but 1 patient with pain relief exhibited a lack of antidiuretic hormone (ADH) production. Interpretation of the data indicates that ADH or its associated neurophysins act as central pain transmitters. The production of these transmitters is decreased or abolished by chemical hypophysectomy through the destruction of hypothalamic nuclei.

Cognition↗
PubMed1979

Treatment of increased intracranial pressure: a comparison of different hyperosmotic agents and the use of thiopental.

Long term intracranial pressure (ICP) monitoring was carried out in over 200 patients with various intracranial abnormalities; a fiberoptic epidural intracranial pressure monitor was used. Ninety of these patients had significantly elevated ICP or exhibited pressure waves requiring therapy. Initial therapy consisted of hyperventilation with a respirator and administration of hyperosmotic agents. Comparison studies utilizing 30% urea, 20% mannitol, and furosemide intravenously and 30% urea and 10% glycerol orally were randomly done. In 45 patients two or more of these agents were used at different times in the same patient for comparison of effectiveness. When equimolar amounts of intravenous urea and mannitol were used, similar effects on increased ICP were obtained. There was no significant reduction of increased ICP with the use of furosemide alone. No rebound effect was observed with either mannitol or urea. Orally, urea was more effective than glycerol in equimolar amounts. Again no rebound was observed. In 14 patients who required doses of hyperosmotic agents more frequently than every 4 hours, continuous infusion of thiopental was used in conjunction with the hyperosmotic agents to control pressure. This regimen resulted in good ICP control in 12 patients. A rational protocol for the medical management of increased ICP utilizing hyperosmotic agents and, in refractory cases, hyperosmotic agents plus thiopental has resulted in effective control of ICP in 96% of our patients throughout their course without the need to resort to decompressive surgery. (Neurosurgery, 5: 570--575, 1979).

Brain Diseases↗
PubMed1979

[Radioisotopic diagnosis of Meckel's diverticulum in children].

The serial scintiphotography following intravenous injection of Tc99m-ertechnetate was used for examination of 50 children aged from 11 months to 14 years. The method is founded on the Tc99m-pertechnetate property of selective accumulation in the gastric mucous membrane and in Meckel's diverticulum when the latter contains the ectopic gastric mucous membrane. The inflamed diverticulum can accumulate the radionuclide, as well. Meckel's diverticulum was suspected in 7 children during examination; in 6 of them Meckel's diverticulum was found peroperatively, and in one case there was enterocyst of the ileum.

Adolescent↗
PubMed1978

Chemical hypophysectomy for relief of bone pain in carcinoma of the prostate.

A series is presented of 10 patients with intractable pain secondary to diffuse metastatic prostatic carcinoma. These patients underwent pituitary ablation by a new method of chemical hypophysectomy, which consisted of multiple injections of absolute alcohol into the pituitary gland under stereotaxic control. Of the 10 patients 9 had good to excellent pain relief. There was no operative mortality. The sequelae are those associated with pituitary destruction, the most significant being diabetes insipidus. Preoperative and postoperative hormonal studies failed to reveal any significant hormonal changes despite good and almost immediate pain relief.

Diabetes Insipidus↗
PubMed1977

Treatment of diffuse metastatic cancer pain by instillation of alcohol into the sella turcica.

The technique of "chemical hypophysectomy" was modified for the management of pain due to metastatic cancer. Using stereotaxic control, a needle is introduced via the nose into the sella turcica. Absolute alcohol is then injected into the pituitary. Of 13 patients who had severe uncontrollable pain, 11 obtained marked symptomatic relief. The longest follow-up period to date is seven months, with results persisting. Sequelae are those associated with destruction of the pituitary gland, the most significant being diabetes insipidus. Several cerebrospinal fluid leaks prompted us routinely to instill alpha-ethyl cyanoacrylate to seal the sella floor. Three patients had slight extraocular nerve palsies. There was no death related to the procedure.

Anesthesia, Spinal↗
PubMed1977

The use of a fiberoptic intracranial pressure transducer in the treatment of head injuries.

A 3-year experience of intracranial pressure monitoring of head-injured patients with a fiberoptic system, and the basic mechanics of the system are discussed. In the overall study, 46 patients were monitored for up to 32 days. There were no infections. Thirty-three patients had elevated pressure, and 16 of these patients required treatment of their elevated pressure. The pertinent findings in intracranial pressure monitoring that may indicate the need for, and the response to, therapy for increased intracranial pressure are also presented. The data obtained from monitoring indicate that intracranial pressure monitoring can also be an aid in the attempt of determine the prognosis of the patient.

Craniocerebral Trauma↗
PubMed1977

Metrizamide--CSF contrast medium. Analysis of clinical application in 215 patients.

Two-hundred-fifteen patients were evaluated with metrizamide, a new water-soluble contrast agent for use in the subarachnoid spaces. Side effects were reported in 67% of these; 39% were moderate or severe. Cervical injections monitored by fluoroscopy provide the most precise positioning of the medium. The benefits of metrizamide use outweigh its risk.

Cerebrospinal Fluid↗