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Biomedical subjects

H J Landy

Publications and source records attributed to H J Landy.

At least 19 recordsLinked to original sources
PubMed1992

Temporal lobectomy for seizures associated with unilateral schizencephaly.

Schizencephaly is characterized by unilateral or bilateral cerebral clefts associated with neurologic deficits and epilepsy. Most commonly schizencephaly is attributed to abnormal neuronal migration, and these malformations are well visualized by current neuroimaging techniques. This report describes a patient with unilateral schizencephaly and poorly controlled complex partial seizures who was found to have a temporal lobe seizure focus; anterior temporal lobectomy produced nearly complete control of the seizures. Despite the extensive malformation, relatively restricted resection was of significant benefit. The principles of seizure focus localization and resection are applicable to the management of patients with schizencephaly.

Adult↗
PubMed1992

Computer controlled stereotaxic radiotherapy system.

A computer-controlled stereotaxic radiotherapy system based on a low-frequency magnetic field technology integrated with a single fixation point stereotaxic guide has been designed and instituted. The magnetic field, generated in space by a special field source located in the accelerator gantry, is digitized in real time by a field sensor that is six degree-of-freedom measurement device. As this sensor is an integral part of the patient stereotaxic halo, the patient position (x, y, z) and orientation (azimuth, elevation, roll) within the accelerator frame of reference are always known. Six parameters--three coordinates and three Euler space angles--are continuously transmitted to a computer where they are analyzed and compared with the stereotaxic parameters of the target point. Hence, the system facilitates rapid and accurate patient set-up for stereotaxic treatment as well as monitoring of patient during the subsequent irradiation session. The stereotaxic system has been developed to promote the integration of diagnostic and therapeutic procedures, with the specific aim of integrating CT and/or MR aided tumor localization and long term (4- to 7-week) fractionated radiotherapy of small intracranial and ocular lesions.

Electromagnetic Phenomena↗
PubMed1992

Obstetric performance in patients with the lupus anticoagulant and/or anticardiolipin antibodies.

Antiphospholipid antibodies, notably the lupus anticoagulant and anticardiolipin antibodies, are associated with recurrent fetal wastage, pregnancy complications, and thromboses. Aggressive medical treatment using aspirin and steroids has been recommended. Fifty-one patients with antiphospholipid antibodies, only four with underlying connective tissue disorders, were followed through 53 pregnancies. Aggressive therapy was used in 33 pregnancies, 90.9% of which resulted in successful obstetric outcomes, a highly statistically significant difference compared with previous pregnancies in the same patients. Most pregnancies among nine patients receiving single-agent therapy (aspirin or steroids alone) and eight patients not treated also had successful outcomes. A 48.6% complication rate was found in association with therapy, particularly gestational diabetes mellitus. There was no statistical correlation between dose or duration of therapy and development of treatment-related complications. Although a subgroup of patients with antiphospholipid antibodies will benefit from aggressive therapy, the high complication rate warrants close observation.

Adrenal Cortex Hormones↗
PubMed1991

Intraoperative ultrasonography and cortical mapping for removal of deep cerebral tumors.

Stereotactic biopsies of brain tumors have recently become frequent, but prognosis may be improved by more aggressive surgery for primary and metastatic tumors. This report describes techniques for debulking and removal of deep cerebral tumors that are commonly subjected only to biopsy. With the use of intraoperative cranial ultrasonography and cortical mapping, five gliomas were debulked and three metastatic lesions were grossly totally removed. No complications occurred, and the patients with metastatic disease had striking neurologic improvement. Deep cerebral tumors may be treated aggressively with appropriate surgical techniques in selected patients.

Adolescent↗
PubMed1990

Small-field stereotactic external-beam radiation therapy of intracranial lesions: fractionated treatment with a fixed-halo immobilization device.

Current techniques of stereotactic, small-field, external-beam irradiation with linear accelerators require treatment with a single fraction or only a few fractions of radiation with large single doses per fraction. Using a radiolucent halo that remained affixed to the cranium with skin-piercing screws, the authors treated 24 patients with a multifraction technique for benign and malignant brain lesions. The objective of this study was to ascertain the feasibility of maintaining the halo in place for a prolonged, multifraction course of treatment, not to assess treatment efficacy. The halo was affixed for multifraction treatments lasting 19-58 days (mean, 38.7 days; median, 40.0 days) and delivered in 16-31 fractions (mean, 24.9 fractions; median, 25.5 fractions). Two of 24 patients experienced superficial skin infection at the site of fixation, but no other significant acute or chronic toxicity attributable to the stereotactic halo was observed. The authors conclude that stereotactic, small-field, precision irradiation can be accomplished with multiple fractions as well as with a single fraction.

Adolescent↗
PubMed1989

Herpes simplex virus.

Genital herpes simplex infection remains an infectious disease having widespread consequences for both adult and neonatal populations. Physicians must understand that the psychologic impact of genital HSV infections frequently is more disabling than the physical manifestations. Sensitivity, compassion, and support are necessary from members of the medical community, and psychologic counseling may help patients cope with HSV and all its implications. Similarly, physicians must downplay the hysteria that has been associated with herpesvirus infections, emerging as a result of intense media coverage in the 1970s and 1980s. Minimizing the number of cases of neonatal herpes through identification of infected women during parturition continues to be important. Recent guidelines suggest a rationale for the management of women at risk for genital HSV. Nevertheless, until newer immunologic and serologic techniques become clinically reliable and allow a correct and rapid diagnosis of herpes simplex infection, identification of the infected woman in labor must be made using detailed clinical history, physical examination, and viral culture.

Acyclovir↗
PubMed1988

Acardiac fetus in a triplet pregnancy.

The acardiac monster represents one of the most severe but rare congenital anomalies. It occurs only in multiple gestations associated with vascular anastomoses between the affected fetus and its co-twin. The prenatal diagnosis of an acardiac fetus must be suspected in any multiple gestation in which cardiac activity cannot be documented sonographically in a growing fetus. We report an acardiac fetus occurring in a spontaneously conceived triplet pregnancy. A review of the literature, including pathogenetic theories and sonographic reports, is discussed.

Abnormalities, Severe Teratoid↗
PubMed1988

MR characterization of brain and brain tumor response to radiotherapy.

This paper describes our experience in using the T1 and T2 relaxation times for quantitative evaluation of brain and brain tumor response to radiation therapy. Twenty-two computed T1 and 22 computed T2 images were obtained from 66 routine inversion-recovery and spin-echo magnetic resonance (MR) brain scans. The relaxation times of the brain tissues, determined from the computed images, were examined as a function of the absorbed dose. Statistical evaluation of the results showed no significant difference between the relaxation times of irradiated and not irradiated tissues, including tumor and normal white matter. Influence of the magnetic field strength and imaging techniques on the computed T1 and T2 values was confirmed. We conclude that the relaxation time values, as obtained today using conventional MR scanner and standard software, are not specific enough to warrant a correct assessment of the acute radiation effect on the brain tissues.

Adolescent↗
PubMed1988

The effect of chronic steroid therapy on glucose tolerance in pregnancy.

We analyzed the records of 26 pregnant patients receiving chronic steroids to assess the combined effect of pregnancy and glucocorticoid administration on glucose tolerance. Five patients (19.2%) developed diabetes mellitus, four of whom required insulin. In a pregnant control group of 1325 patients, 53 patients (4.0%) developed diabetes mellitus, five of whom required insulin. Glucose intolerance was significantly higher in the steroid-treated group (p = 0.003). Comparison with a nonpregnant steroid-treated control group (47 patients, 15% of whom developed diabetes mellitus) showed no significant different (p = 0.23) between the two. All pregnant steroid-treated patients developing diabetes mellitus began steroid therapy after conception, whereas none of the patients receiving steroid therapy before conception developed glucose intolerance (p = 0.012). There does not appear to be an additive effect of steroid treatment and pregnancy on glucose intolerance; however, all patients receiving steroids should undergo periodic glucose screening.

Adult↗
PubMed1987

Genetic implications of idiopathic hydramnios.

The antenatal diagnosis of hydramnios requires a careful search for associated underlying maternal or fetal conditions. Even in pregnancies associated with idiopathic hydramnios in which no underlying condition can be identified, a high perinatal mortality rate exists. Although trisomy 18 has been seen in pregnancies with hydramnios and growth retardation, the association with specific chromosomal disorders and idiopathic hydramnios has not been well defined. A review of pregnancies complicated by hydramnios was undertaken; 99 cases with complete pregnancy and delivery information were identified. Fifty-nine pregnancies were complicated by idiopathic hydramnios, and except for the hydramnios, sonographic evaluation was normal. Delivery information revealed one infant with trisomy 18 and eight infants with structural anomalies not appreciated antenatally. Of the undiagnosed malformations, 25% are frequently associated with trisomy 21. We recommend fetal chromosomal analysis as an adjunct to the evaluation of pregnancies complicated by idiopathic hydramnios.

Chromosomes, Human, Pair 18↗
PubMed1987

Postabortal septic pelvic thrombophlebitis diagnosed with computed tomography. A case report.

Septic pelvic thrombophlebitis is an uncommon complication in obstetrics and gynecology that may be difficult to diagnose clinically. Computed tomography (CT), an accurate and noninvasive modality, has greatly aided in the diagnosis of this disorder. In a case of septic pelvic thrombophlebitis complicating second-trimester pregnancy termination, CT enabled the correct diagnosis to be made and treatment to be initiated.

Abortion, Induced↗
PubMed1987

May-Hegglin anomaly in pregnancy. A case report.

The May-Hegglin anomaly is a rare autosomal dominant platelet disorder that can be associated with significant bleeding. We treated a patient for pregnancy complicated by the May-Hegglin anomaly and a complete placenta previa.

Adult↗
PubMed1986

The "vanishing twin": ultrasonographic assessment of fetal disappearance in the first trimester.

Review of the sonographic findings of 1000 pregnancies with viable gestations in the first trimester revealed a minimum incidence of twinning of 3.29%. Of these, 21.2% demonstrated the "vanishing twin" phenomenon, often with associated bleeding, but with a good prognosis for the remaining fetus. Ovulation induction did not appear to alter these data. The sonographic criteria for "vanishing twin" are discussed. The incidence of multiple gestation is 3.29% to 5.39%, higher than previously believed.

Diagnostic Errors↗
PubMed1978

Controlled clinical study of naltrexone side effects comparing first-day doses and maintenance regimens.

In a controlled double-blind clinical study, 42 patients reported side effects and severity of side effects to naltrexone on three different first-day doses and maintenance dosage regimens. Initiating doses of 25, 100, and 150 mg were administered. The maintenance regimens involved 350 mg of naltrexone per week for 4 weeks with drug administration in Group A, five times weekly; in Group B, three times weekly; and in Group C, twice weekly. All three groups received identical doses for the last dosage administered each week. The first-day doses produced no significant quantitative difference in side effects. Overall, the three groups reported little difference in side effects. Nonetheless, the regimen with the least number of patients reporting side effects daily was that of Group B. In no case, regardless of dose or dosage regimen, did any patient have side effects of such a nature as to require termination of their participation in the study.

Administration, Oral↗