PubMed Health⌕ Search

Biomedical subjects

D B Levine

Publications and source records attributed to D B Levine.

At least 19 recordsLinked to original sources
PubMed2000

Hospital for special surgery. A brief review of its development and current position.

On May 1, 1999, the Hospital for Special Surgery was 136 years old. To present a history that does adequate justice to the many people, who have been or still are involved in the making of it, is an impossible task. Nevertheless, this document is important because the hospital, first under the name of Ruptured and Crippled and then under that of Special Surgery has played such an important role in the development of orthopaedics and rheumatology in America during the past century. The reader must forgive an orthopaedic bias to this account and also realize the limitation of space that makes it at best fragmentary and incomplete. The account begins with a description of the hospital's current situation, physical layout and governance. A terse history of the hospital's origin and subsequent development follows, which includes a more specific description of the growth of its orthopaedic surgical services. Finally, separate records of the 112-year-old Postgraduate Orthopaedic Educational Program and 44-year-old Research Division are presented.

Education, Medical, Graduate↗
PubMed1998

Optimizing hospital reimbursement through physician awareness: a step toward better patient care.

We instituted a training program to improve the overall accuracy of medical record coding through greater physician awareness to enhance hospital reimbursement and maintain quality patient care. A physician-targeted course reviewed the prospective payment system, diagnosis-related group guidelines, ambulatory surgery reimbursement, and the relationship between accurate physician documentation and medical record coding. Annual increases in charges from prospective surgical case assignment, proper conversion of outpatient to inpatient status, and more accurate coding of inpatient comorbidities and complications led to an estimated increase in hospital charges of $1.6 million.

Ambulatory Surgical Procedures↗
PubMed1995

Scoliosis in familial dysautonomia. Operative treatment.

The results of operative treatment of scoliosis were reviewed for twenty-two patients (ten boys and twelve girls) who had familial dysautonomia, an autosomal recessive disorder affecting primarily Ashkenazi Jews. The indication for operative intervention was progressive kyphoscoliosis to 45 degrees or more in a skeletally immature patient for whom bracing had failed. The mean age at the time of the operation was fifteen years and five months (range, eight years and two months to nineteen years). Seventeen patients had a thoracic curve with a mean preoperative Cobb angle of 69 degrees (range, 47 to 112 degrees), and five patients had a double major curve with a mean preoperative Cobb angle of 71 degrees (range, 42 to 87 degrees) for the cephalad curves and 60 degrees (range, 45 to 72 degrees) for the caudad curves. Twenty patients had a rigid kyphosis; in fourteen, the apex was at the seventh thoracic vertebra or more cephalad. Two patients had a lordoscoliosis. The mean preoperative kyphosis was 64 degrees (range, 12 to 110 degrees) in the thirteen patients who had a thoracic curve and for whom information regarding kyphosis was available, and it was 70 degrees (range, 54 to 84 degrees) in the five patients who had a double major curve. Postoperior spinal arthrodesis and instrumentation was performed in all patients. Two patients had an anterior arthrodesis as well because of the severity and rigidity of the curve. Allograft bone was used in eighteen patients. Postoperatively, all patients were managed with a body cast or with a custom-molded thoracolumbar brace.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

Cost awareness and cost containment at the Hospital for Special Surgery. Strategies and total hip replacement cost centers.

To help balance the operating budget of The Hospital for Special Surgery, which was encountering an annual major deficit of $4 million in 1989, a program of cost awareness leading to cost containment was instituted in 1990. Costs of supplies, implants, and equipment were identified and reviewed by the hospital staff, including orthopaedic surgeons, orthopaedic residents, health care personnel, and administration, for cost effectiveness. Methods to accomplish the goals included structuring committees for information; workshops organized by different services to affect change; feedback to health care professionals through posters and newsletters; and statistical identification for continued education. Major cost savings resulted from recycling wasted implants, reduction of costly implants, and reduction of unnecessary supplies. As a result, vendors had been challenged, leading to more competitive prices. This program has opened new avenues of cost reduction without sacrificing quality of medical care and has contributed to a breakdown of barriers between medical staff, administration, and finance, leading to a strong hospital-team commitment. The price of health care in the United States in 1993 exceeded $900 billion. Health care expenditures now account for approximately 14% of the gross domestic product. Health care costs have been rising faster than the inflation rate for more than a decade. The result is the current national focus on containment of health care expenditures.

Cost Control↗
PubMed1992

Salvage and reinfusion of postoperative sanguineous wound drainage. A preliminary report.

Thirty-five patients who were to have posterior spinal arthrodesis, total hip arthroplasty, or total knee arthroplasty were entered into one of two groups: Group A, to receive unwashed, filtered sanguineous drainage from the wound, or Group B, to receive washed, filtered drainage. The purpose of this prospective study was to evaluate the safety, efficacy, and difficulty of reinfusion of washed compared with unwashed drainage that had been salvaged from the wound after an orthopaedic operation. The sixteen patients in Group A received a mean of 475 milliliters of unwashed drainage for each total knee arthroplasty, 427 milliliters for each total hip arthroplasty, and ten milliliters for the one posterior spinal arthrodesis. The complications included immediate hypotension (two patients), hyperthermia (one patient), and hypotension five hours after reinfusion (one patient). The latter patient died, four days after the operation, of a massive myocardial infarction. The nineteen patients in Group B received a mean of 193 milliliters of washed, filtered drainage for each total knee arthroplasty, 203 milliliters for each total hip arthroplasty, and 179 milliliters for each posterior spinal arthrodesis. Salvage and reinfusion of washed drainage from the wound caused no problems in these patients.

Adolescent↗
PubMed1991

Percutaneous computed-tomography-guided biopsy of the thoracic and lumbar spine.

Axial computed tomographic scans were used to guide percutaneous needle biopsies in 76 patients with thoracic and lumbar spinal lesions. Prebiopsy evaluation included spine radiographs, radionuclide bone scans, computed tomographic scans, magnetic resonance imaging scans in some cases, and coagulation studies. Forty-five patients were diagnosed as having metastatic lesions, 11 infection, and 12 primary bone tumors. Of all patients, 34 had lytic vertebral lesions with significant collapse and questionable spinal stability. Six of those had a concomitant paravertebral mass. A clinical and pathologic correlation was completed for each of the cases studied. Histologic diagnosis confirming the clinical suspicion was obtained on the first biopsy attempt in 65 (86%) of the 76 cases.

Biopsy, Needle↗
PubMed1990

Scoliosis.

Explore the source record for details and available documents.

Adolescent↗
PubMed1988

Osteoporosis in Scheuermann's disease.

A prospective study was undertaken to evaluate osteoporosis in Scheuermann's disease. Ten consecutive untreated patients with thoracic Scheuermann's were studied. The mean age was 16 years, 1 month, and the mean kyphosis was 64 degrees. Osteoporosis was quantitated by single and dual photon absorptiometry. Seven age-, sex-, height-, and weight-matched subjects were used as controls. The mean bone mineral density (BMD) of the lumbar spine was 0.975, compared with 1.130 for the control group, significant at P less than 0.025. For patients with a kyphosis greater than 45 degrees, the BMD was 0.913, significant at P less than 0.005. The mean BMD of the femoral neck was 1.00, compared with 1.22, significant at P less than 0.005. For patients with a kyphosis greater than 45 degrees, the femoral neck BMD is 0.983, significant at P less than 0.005. The BMD of the radius by single photon absorptiometry was 0.689, compared with 0.748 in the controls, which was not significant. In patients with a kyphosis greater than 45 degrees, the BMD was 0.655, which is significant at P less than 0.01. A highly significant association exists between osteoporosis and Scheuermann's disease. Further investigation is indicated to determine the role of medical management in the treatment of these patients.

Adolescent↗
PubMed1987

Long-term psychological sequelae of surgically versus nonsurgically treated scoliosis.

Forty-six female scoliosis patients (21-34 years of age) were tested psychologically 4 or more years following treatment. Twenty-three had been treated by bracing (Group A) and 23 by posterior spinal fusion (Group B). Variables evaluated were: self-esteem, capacity for intimacy, sexual satisfaction, and mental representation of the patient's own body (body image). The prediction that normal controls would show better psychological adjustment than scoliotic women--surgically treated or not--was only partially borne out. Contrary to expectations, both groups of scoliotics showed higher levels of sexual satisfaction than controls. Group B showed a greater need for intimacy and better sexual adjustment, self-esteem, and body image than Group A.

Adult↗
PubMed1986

Long-term follow-up of spinal fusion in spinal muscular atrophy.

From 1966 to 1983, 11 females and eight males with spinal muscular atrophy were treated by arthrodesis. Seventeen of 19 patients were evaluated by follow-up physical examination, roentgenograms, and questionnaires. In order to compare long-term versus short-term results, changes in management, and factors contributing to morbidity and mortality, three groups were identified for study. Group I consisted of 11 patients operated between 1966 and 1983 and alive at follow-up evaluation. Group II consisted of five patients operated between 1980 and 1983. Group III consisted of three patients, all deceased at follow-up evaluation and operated before 1980. In Group I, the preoperative curve averaged 119 degrees and at final follow-up examination, 99 degrees. The average preoperative curve in Group II was 80 degrees and at follow-up examination, 49 degrees. Long-term follow-up vital capacities were obtained in nine patients. The average preoperative vital capacity was 1033 cm3, and the average vital capacity seven years postoperation was 860 cm3. Most patients reported improvement in sitting, balance, and comfort. All patients are wheelchair-bound, as they were before surgery. Few long-term respiratory problems were reported.

Adolescent↗
PubMed1985

Creatine kinase MB in skeletal muscle and serum of spine-fusion patients.

The low specificity of creatine kinase (CK) MB elevations for myocardial infarction was confirmed by a prospective analysis of paraspinal muscle and postoperative serum levels of CK-MB. Eleven of 30 patients had serum elevations of CK-MB without myocardial infarction. Elevated CK-MB was not specific for myocardial infarction after spine surgery. CK-MB was found in paraspinal muscle of 93% of patients. CK-MB may be a pathologic marker in patients with spinal disease.

Adolescent↗
PubMed1984

The effects of internal fixation on the articular cartilage of unfused canine facet joint cartilage.

Custom-made distraction instrumentation was placed in the lumbar spine of eight large dogs with care taken to preserve the integrity of two intervening apophyseal joints. Histologic staining of immobilized joint cartilage showed varying degrees of chondrolysis, cloning, invasion of the tide mark, and loss of proteoglycans as early as 2 months postoperatively. Every specimen had significant degenerative changes characteristic of osteoarthritis. The joints one segment caudal to the lower hooks also were examined and were found to have similar histologic evidence of degeneration. Three dogs had the instrumentation removed and were then sacrificed 1.5-3 months later. The degenerative changes were not reversible following instrumentation removal.

Animals↗
PubMed1983

Evoked potentials recorded from scalp and spinous processes during spinal column surgery.

Peroneal nerve evoked potentials were simultaneously recorded from scalp and from wire electrodes inserted into lumbar and thoracic spinous processes at multiple levels during surgery for correction of spinal column curvature in 43 patients. Spinal potentials progressively increased in latency rostrally. Over cauda equina and rostral spinal cord initially positive triphasic potentials were recorded. Over caudal spinal cord the response consisted of initial positive-negative diphasic potentials that merged with broad large negative and positive potentials. At rapid rates of stimulation, the initial diphasic component was stable but the subsequent potentials significantly diminished in amplitude. This suggests that the diphasic component reflects presynaptic activity arising in the intramedullary continuations of dorsal root fibers and that the subsequent components reflect largely postsynaptic activity. Scalp recordings at restricted bandpass (30-3000 c/sec) revealed well defined positive and negative potentials with mean peak latencies of 25.9 and 29.9 msec (PV-N1). The amplitudes and latencies of PV-N1 remained relatively stable throughout general anesthesia with halogenated agents which suggests that this component may be a reliable monitor of conduction within spinal cord afferent pathways during spinal surgery. Data are presented which suggest that selective filtering may help to distinguish faster frequency, synchronous axonal events from slower frequency, asynchronous axonal or synaptic events.

Adolescent↗
PubMed1983

Physical therapy management of familial dysautonomia.

This paper describes physical therapy programs to assist physical therapists in the rehabilitation of patients with familial dysautonomia. There have been no reports in the literature about a physical therapy program for patients with this disease. A retrospective analysis of the clinical manifestations in 80 patients in a dysautonomia clinic was performed. Scoliosis and kyphosis were found in 92 percent of the patients, 93 percent had ataxia, 74 percent had feeding difficulties, 69 percent had frequent pneumonias, and 63 percent exhibited delayed developmental milestones. Cardiovascular, gastrointestinal, pulmonary, musculoskeletal, and neurological symptoms and treatments are discussed.

Adolescent↗
PubMed1982

The part-time Milwaukee brace treatment of juvenile idiopathic scoliosis. Long-term follow-up.

A long-term follow-up in 15 patients who had juvenile idiopathic scoliosis was instituted to determine the efficacy of a part-time Milwaukee brace program. The patients were divided into two groups. In Group I patients, part-time bracing was successful in controlling the scoliosis. The average curvature at the onset of bracing was 32 degrees, and the final curvature was 28 degrees. None of the final curvatures increased more than 7 degrees from the initial curvatures. In Group II patients, following six years of part-time bracing, the patients ultimately were treated by posterior fusion and Harrington instrumentation. All of these patients had curvatures greater than 35 degrees at the onset of part-time bracing. All patients who had curvatures less than 35 degrees at the onset of part-time bracing and whose rib--vertebrate angle difference (RVAD) remained less than 20 degrees were successfully treated without surgery. All patients who had curvatures of greater than 45 degrees at the onset of bracing and whose RVAD exceeded 20 degrees eventually underwent spinal fusion. A consistent finding of vertebral body half-wedging was noted on the side of the concavity. The persistence of this finding appeared to correlate well with the patients clinical response.

Adolescent↗
PubMed1979

Intellectual development and familial dysautonomia.

The study examined adaptive trends in cognitive development among individuals with familial dysautonomia and sought to establish new base rates of intelligence for the dysautonomic population. Fifty-two subjects, aged 6 to 28 years, were administered the Wechsler scales of intelligence. The results indicate that there is less cognitive impairment than previous research would suggest, and that more dysautonomic children are capable of adjusting to standard school programs than was heretofore thought possible. Specific deficits seen in this population are discussed along with a rationale for deleting the term retarded where most of these individuals are concerned.

Adolescent↗