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Biomedical subjects

A H Levkoff

Publications and source records attributed to A H Levkoff.

At least 19 recordsLinked to original sources
PubMed1992

Relatedness of strains of methicillin-resistant coagulase-negative Staphylococcus colonizing hospital personnel and producing bacteremias in a neonatal intensive care unit.

The emergence of methicillin-resistant coagulase-negative Staphylococcus as a major bacterial pathogen in neonatal intensive care units has stimulated interest in the epidemiology of spread of the organism. During a 12-month "epidemic" of bacteremias with methicillin-resistant coagulase-negative Staphylococcus we compared the characteristics of bacteremic and personnel nasally-carried strains by traditional and biomolecular methods. Sixty-two percent of neonatal intensive care unit nurses were colonized with methicillin-resistant coagulase-negative Staphylococcus with similar speciation to bacteremic strains. Inspection of plasmid profiles revealed a moderate degree of similarity between bacteremic and colonizing strains although genomic DNA restriction patterns showed diversity. Ribotype patterns were highly conserved (90%) in personnel strains. A 2.6-kilobase plasmid DNA probe hybridized to similarly sized plasmids and larger plasmids in one-half of the strains. We hypothesize that related methicillin-resistant strains may be transferred among personnel and neonates in the neonatal intensive care unit. Epidemiologic studies of coagulase-negative staphylococci should consider multiple molecular techniques to relate strains.

Bacteremia↗
PubMed1991

Birth weights of infants of black and white mothers without pregnancy complications.

An analysis of 10,159 normal spontaneous vaginal deliveries was performed to examine racial differences in mean birth weight of infants whose mothers were without antepartum or intrapartum medical complications of pregnancy. The study was limited to black and white infants of low-income mothers who were inborn, singleton, and weighed greater than or equal to 500 gm at birth. High-risk maternal transfer patients and patients with hypertension, toxemia, bacteriuria, pyelonephritis, renal failure, diabetes, anemia, polyhydramnios, oligohydramnios, prolapsed cord, vaginal bleeding, placenta previa, abruptio placentae, prolonged rupture of membranes, maternal fever on admission, amnionitis, sexually transmitted diseases, or fewer than five prenatal care visits were excluded. When statistically significant differences in demographic characteristics were controlled, black infants had an average birth weight 181 gm less than that of white infants.

Birth Weight↗
PubMed1991

Differences in black and white infant birth weights: the role of maternal demographic factors and medical complications of pregnancy.

In a retrospective study of 18,631 deliveries among women of low income, we examined the association of racial disparities in mean birth weight with population differences in maternal demographic characteristics and antepartum-intrapartum medical complications. The study population consisted of inborn, nonreferred, singleton, low-income patients delivered on the nonprivate service after at least five prenatal care visits. Repeat cesarean sections were not included. The mean birth weight for black infants was 214 g less than that for white infants. Black and white mothers differed significantly in marital status, age, and years of education. Black and white mothers also differed significantly in the incidence of chronic hypertension, preeclampsia-eclampsia, anemia, amnionitis, fever on admission, and sexually transmitted diseases. In this population, controlling for maternal demographic characteristics and medical complications of pregnancy produced a predicted mean birth weight for black infants that was 100 g less than that for white infants (53% of the observed racial difference in mean birth weight).

Adult↗
PubMed1990

Intrahepatic encystment of umbilical vein catheter infusate.

Massive hepatomegaly in a 2.1 kg female infant, with an indwelling umbilical vein catheter for total parenteral nutrition, occurred on the 10th day of life. Ultrasound and computed tomography studies revealed a large hepatic cyst filled with the catheter infusate. Percutaneous drainage brought about subsequent recovery. To our knowledge, this complication of umbilical vein catheter use has not been previously reported.

Catheterization, Central Venous↗
PubMed1990

Multiple rhabdomyomatous mesenchymal hamartomas of skin.

A case of multiple rhabdomyomatous mesenchymal hamartomas is presented. The patient is a black male infant, the product of an uncomplicated term gestation and delivery. At birth, there were numerous polyps distributed over the periorbital and periauricular areas bilaterally. Some appeared fingerlike with constrictions below their tips. Others were branched or globular in shape. These projections showed spontaneous and independent movement, particularly during feedings. On histopathologic examination, the polyps were covered by squamous epithelium and contained normal follicular units. Bundles of skeletal muscle were present in the reticular dermis, extending into the subcutis. Regular cross-striations were seen in these muscle fibers. In some specimens, the muscle bundles formed a solid, central core. Skeletal muscle histochemical stains confirmed the presence of both types 1 and 2 muscle fibers. Electron microscopy revealed a normal skeletal muscle banding pattern. This case is the first report of multiple rhabdomyomatous mesenchymal hamartomas of skin. Functional skeletal muscle with spontaneous movement is part of the clinical picture.

Diagnosis, Differential↗
PubMed1989

Epidemic methicillin-gentamicin-resistant Staphylococcus aureus in a neonatal intensive care unit.

Between October 1985 and August 1986, 49 isolates of methicillin-resistant Staphylococcus aureus (MRSA) were obtained from 26 neonates in the neonatal intensive care unit (NICU) at the Medical University Hospital, Charleston, SC. Sites of MRSA isolation were the respiratory tract (33%); nasopharynx (12%); gastrointestinal tract (12%); eye (8%); blood (6%); and catheter tips, wounds, or umbilicus (29%). Very low birth weight was a significant risk factor for MRSA acquisition. All isolates had the same phage type (47/54/75/83A), antibiogram, and whole-cell protein profile. Agarose gel electrophoresis of all 49 isolates disclosed a plasmid level of approximately 45 X 106 daltons (45 megadaltons) in ten different isolates and no plasmid DNA in 39 isolates. Cultures of NICU personnel failed to disclose MRSA carriers and environmental cultures for MRSA were negative. Ten selected isolates showed lower minimal bactericidal concentrations for hexachlorophene than for chlorhexidine. Standard infection-control measures such as contact isolation, hand washing with chlorhexidine, and cohorting (when possible) failed to contain the epidemic. Ultimately, eradication of MRSA from the NICU was associated with the institution of hexachlorophene hand washing.

Cross Infection↗
PubMed1987

Median cleft of the upper lip associated with lipomas of the central nervous system and cutaneous polyps.

An unusual combination of three rare developmental anomalies, ie, complete median cleft lip, cutaneous polyps, and midline lipomas of the central nervous system, was discovered in a male newborn. Inguinal hernia, cryptorchidism, and clinodactyly of the fifth fingers were other features. His mother was found to have clinodactyly, antimongoloid slant to her palpebral fissures, and computed tomography (CT) scan evidence of asymptomatic hydrocephaly. Family history and clinical investigations did not reveal any clues to etiology. This combination of findings may represent a new syndrome or another expression of frontonasal dysplasia.

Brain Neoplasms↗
PubMed1987

High levels of group-specific component (vitamin-D-binding protein) in the cerebrospinal fluid of infants aged less than 2 months.

Because of the possible involvement of group-specific component (Gc) or vitamin-D-binding protein in the immunological functions of mononuclear cells and the increased risk of central nervous system infections in early infancy, we studied Gc levels in the cerebrospinal fluid (CSF) of children. CSFs were examined for the Gc concentration using ELISA and rocket immunoelectrophoresis, with purified Gc as standard. The results showed a significant inverse correlation (p less than 0.05) between the age of the patients and CSF Gc levels. Gc levels in the CSF were significantly increased in infants less than 2 months of age (12.5 micrograms/ml), as compared to infants greater than 2 months (1.7 micrograms/ml, p less than 0.0028). In children greater than 2 months of age a significant correlation was found between Gc levels and those of other CSF proteins (albumin, IgG and total protein, p less than 0.002). However, no significant correlation between Gc levels and those of other CSF proteins was apparent in infants less than 2 months of age, indicating the possibility that the concentration of Gc in the CSF may be selectively increased in this age group.

Aging↗
PubMed1985

Renal failure and other serious sequelae of epinephrine toxicity in neonates.

Epinephrine has numerous potent pharmacologic actions with protean manifestations. We have described a patient in whom inadvertent intra-aortic administration of a large dose of racemic epinephrine produced serious adverse effects, including hypertension, acidemia, tachycardia, and protracted but reversible renal failure. In view of the ubiquitous use of epinephrine in neonatal intensive care, we hope that this report heightens awareness of its more serious and potentially fatal toxic effects.

Acute Kidney Injury↗
PubMed1985

Effect of neonatal cerebrospinal fluid on monocyte chemotaxis.

We have reported in our previous study that macrophages constitute 58% of the total number of white cells in noninfected neonatal cerebrospinal fluid (CSF). CSF macrophages are probably derived from blood monocytes. To explain their predominance, we compared the chemotactic response of monocytes from cord and adult blood to neonatal (NCSF) and non-neonatal spinal fluids (NNCSF). Zymosan-activated serum (ZAS) was used as a positive control. Significance was accepted as p less than or equal to 0.05. We observed that both random migratory (RM) activity and chemotactic responses (CM) of cord monocytes to neonatal CSF and ZAS were greater than those of monocytes obtained from adult blood, resulting in a significant increase in the chemotactic differential (CD). Chemotactic responses of neonatal monocytes were significantly greater in the presence of neonatal CSF as compared to CSF from older children as indicated by CD. The CD of neonatal monocytes to neonatal CSF was greater than that of neonatal neutrophils. These findings are consistent with the presence of specific monocyte chemotaxins in noninfected neonatal CSF.

Adolescent↗
PubMed1984

Primary renal candidiasis in two preterm neonates. Report of cases and review of literature on renal candidiasis in infancy.

Primary renal candidiasis and hydronephrosis were diagnosed in two premature neonates in whom systemic hypertension developed. The clinical course in these patients and in 16 patients with renal candidiasis described in the literature indicated that prematurity, use of broad-spectrum antibiotics, and use of intravenous (IV) catheters are predisposing factors. Anuria and flank mass were the initial manifestations in the reviewed cases. Only four of the 16 patients survived following either antifungal therapy or nephrectomy. Both of our patients survived after antifungal therapy with amphotericin B and flucytosine for systemic effect as well as topical instillation of amphotericin B solution via a nephrostomy. We believe that a high index of suspicion in infants at risk and early institution of antifungal therapy for systemic as well as topical effect can improve the outcome in infants with renal candidiasis.

Amphotericin B↗
PubMed1984

Brain calcification in severely stressed neonates receiving parenteral calcium.

Morphologic evidence for calcium salts within the brains of severely stressed neonates at autopsy correlated to the mean daily parenteral dose of calcium gluconate (P less than 0.01). Survival analysis indicated that parenteral administration of calcium contributed a negative effect to predicted survival (P less than 0.05).

Brain Diseases↗
PubMed1984

Multimodal assessment of human brain calcification with respect to parenteral calcium gluconate in stressed neonates.

Parenteral calcium may augment the degree of calcification within brains of human neonates (p less than 0.01). This observation is supported by histochemistry, atomic absorption of ashed brain, selected area diffraction, and energy dispersive microanalysis. Survival analysis indicates that a standard replacement dose may have an adverse effect of severely stressed neonates (p less than 0.01). Nuclei within the optic-tract, circumferential pons and temporal lobe showed calcium salt deposits before other cytologic evidence of necrosis was discernible. Most calcification occurred in regions of ongoing necrosis primarily in the neuropil. But Purkinje cell and supraoptic neurons and apparent neurons from the fascia dentata, Ammon's Horn, were densely calcified in several brains. In those infants surviving longer periods both the neuropil and nuclei of glial scar stained for calcium salts.

Brain↗
PubMed1982

Maternal risk factors in infants with very low birth weight.

To determine whether maternal risk factors associated with the delivery of very low birth weight infants under 1501 g are different from those associated with low birth weight infants of 1501 to 2500 g, prenatal data on 12,247 deliveries were evaluated. The sample contained 302 very low birth weight infants. Maternal race, age, height, weight, gravidity, parity, past pregnancy performance, and pregnancy complications were analyzed. Factors related to very low birth weight but not to low birth weight infants were previous abortions, previous fetal deaths, and hypertensive vascular disease. Race, maternal height, and prepregnancy weight were not related to very low birth weight but were associated with an increase in low birth weight. There was no significant difference in the rate of very low birth weight or low birth weight by maternal age from 14 to 40 years. These results contradict the concept of a uniform set of predisposing factors for birth of all infants weighing 2500 g or less.

Abortion, Spontaneous↗