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D J Lanska

Publications and source records attributed to D J Lanska.

At least 19 recordsLinked to original sources
PubMed2000

Romberg's sign: development, adoption, and adaptation in the 19th century.

In the first half of the 19th century, European physicians-including Marshall Hall, Moritz Romberg, and Bernardus Brach-described loss of postural control in darkness of patients with severely compromised proprioception. Romberg and Brach emphasized the relationship between this sign and tabes dorsalis. Later, other neurologists evaluated the phenomenon in a broader range of neurologic disorders using a variety of simple but increasingly precise and sensitive clinical tests. Although now known as Romberg's sign, among neurologists in the late 19th century this phenomenon was sometimes credited to Romberg, sometimes to both Brach and Romberg, and sometimes discussed without attribution.

History, 19th Century↗
PubMed2000

Surgeon characteristics associated with mortality and morbidity following carotid endarterectomy.

PURPOSE: To identify surgeon characteristics associated with mortality or morbidity, following carotid endarterectomy (CEA). METHODS: Data on all inpatient discharges from the 284 nonfederal Pennsylvania hospitals were obtained from the Pennsylvania Health Care Cost Containment Council for the period from 1994 to 1995. Physician data were obtained from the Physicians List of the American Medical Association, including name, gender, specialty, year of birth, board certified, and year of licensure. Cases were selected if any of six procedures codes were ICD-9-CM rubric 38.12, indicating CEA. RESULTS: Among the 12,725 cases studied, in-hospital mortality was 0.7%, nonfatal morbidity was 3.0%, and the total bad outcome rate was 3.7%. Surgeons who performed 1 to 2 CEAs over 2 years had the highest mortality (2.0%) and total bad outcome (9.2%) rates. For surgeons performing three or more cases in 2 years, increased volume was not associated with better outcomes. A greater number of years since the surgeon was licensed was associated with greater mortality (p = 0.001), but not with morbidity or bad outcome rates. In regression analyses that adjusted for patient risk, both years since licensure and specialty predicted surgical mortality rate, but only volume predicted surgical bad outcome rate. CONCLUSIONS: More years since licensure and very low patient volume are associated with worse patient outcomes following CEA.

Adult↗
PubMed2000

William Hammond, the dynamometer, the dynamograph.

The dynamometer came into general use by neurologists in the late 19th century. Various dynamometers were developed and adopted by neurologists at that time to measure muscle strength, in keeping with the general trend of adopting instrumentation to distinguish our specialty and aid observation and diagnosis. Many dynamometers were adaptations of the French Mathieu dynamometer, which was initially promoted by American neurologist William Hammond. Another variation, the Mathieu dynamograph, used to graphically record measurements made with a dynamometer, was also initially studied, used, and promoted by Hammond. The high cost of the dynamograph and the lack of demonstrated clinical utility contributed to its limited dissemination. The history of the dynamometer and the dynamograph illustrate both the practical difficulties associated with developing a new instrument, and the numerous modifications that such an instrument goes through, some of which have little to do with practical application.

Equipment Design↗
PubMed2000

19th-century American contributions to the recording of tremors.

Studies of tremor in the 19th century were based initially on simple observation and later on the use of crude graphic recording devices that had been modified from instruments developed for other purposes. Like several European contemporaries, American investigators studying tremor used and adapted various existing instruments, including tambours and sphygmographs. A tambour used a drum-shaped pneumatic mechanism to transmit movements to a recording instrument, whereas the sphygmograph was a nonpneumatic mechanical device initially used to record the pulse. 19th-century American neurologists who used such devices included Frederick Peterson, Hobart Amory Hare, Charles Loomis Dana, and Augustus A. Eshner. Their measurements of tremor frequency were generally consistent with modern estimates for various types of tremor. Eshner, in particular, was frustrated by the overlap of frequency domains for tremors in different diseases, because this precluded use of tremor frequency alone as a differentiating feature for diagnosis. Peterson and Dana recognized the variation in tremor frequency in different body parts resulting from different natural resonance frequencies of these parts as a function of weight and elastic properties. Peterson, Dana, and Eshner also recognized that tremor amplitude and frequency are inversely related. Finally, these 19th-century investigators recognized that the tremor of Parkinson's disease is a relatively low-frequency rest tremor, suppressed by action, and generally synchronous in symmetric body parts, but varying in amplitude and frequency in different body parts or over time.

History, 19th Century↗
PubMed2000

George Huntington (1850-1916) and hereditary chorea.

Although Huntington's disease has existed since at least the seventeenth century, and although several physicians provided earlier descriptions of hereditary chorea, Huntington's disease was not generally recognized until the classic description by George Huntington (1850-1916) in 1872. This paper--on the sesquicentennial of Huntington's birth--reviews Huntington's original and later contributions to the description of this disorder, his professional presentations and correspondence on the topic, and his publications, as well as his background, medical training, and clinical practice. The characteristics of Huntington's disease recognized by George Huntington in 1872--i.e., the distinct clinical profile, midlife onset, and autosomal dominant inheritance pattern--made the disease ideal for investigation by genetic linkage analysis a century after Huntington's description. Subsequent breakthroughs have identified the genetic defect as an unstable expanded CAG trinucleotide repeat mutation in a novel gene on the short arm of chromosome 4. The rapidity of recent discoveries bodes well for further significant progress in understanding, and hopefully treating, this profoundly debilitating neurodegenerative disorder.

Disease Progression↗
PubMed2000

Risk factors for peripartum and postpartum stroke and intracranial venous thrombosis.

BACKGROUND AND PURPOSE: The study goal was to identify potential risk factors for peripartum or postpartum stroke and intracranial venous thrombosis. METHODS: Data from the Healthcare Cost and Utilization Project were analyzed for the years 1993 and 1994. Observed values were weighted with poststratification discharge weights to project to the universe of all discharges from community hospitals located in the United States. Nationally representative estimates of risk were calculated on the basis of age, race, mode of delivery, income, third-party payer, hospital size, hospital ownership, hospital location (rural versus urban), hospital teaching status, census region, and presence of specific complications. Multivariate models were developed with the use of logistic regression. RESULTS: Among 1 408 015 sampled deliveries, there were 183 observed cases of peripartum stroke and 170 cases of peripartum intracranial venous thrombosis in 17 states in the United States in 1993 and 1994. There were an estimated 975 cases of stroke and 864 cases of intracranial venous thrombosis during pregnancy and the puerperium in the United States among 7 463 712 deliveries during 1993 and 1994, for estimated risks of 13.1 cases of peripartum stroke and 11.6 cases of peripartum intracranial venous thrombosis per 100 000 deliveries. Multivariate analysis showed that the following were strongly and significantly associated with both peripartum and postpartum stroke: cesarean delivery; fluid, electrolyte, and acid-base disorders; and hypertension. Covariates that were strongly and significantly associated with both peripartum and postpartum intracranial venous thrombosis included cesarean delivery, hypertension, and infections other than pneumonia and influenza. CONCLUSIONS: Pregnancy-related hypertension and cesarean delivery are important risk factors for both stroke or intracranial venous thrombosis.

Acid-Base Imbalance↗