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Biomedical subjects

L A Levine

Publications and source records attributed to L A Levine.

At least 19 recordsLinked to original sources
PubMed1992

Stepladder incision technique for lengthening of bowel mesentery.

A tension-free bowel anastomosis is essential when bowel segments are used in reconstructive urological procedures. A safe and effective technique is described to lengthen the mesenteric vascular pedicle. Serial incisions are made in the mesenteric peritoneum horizontally, perpendicular to the vascular plane on both sides of the mesentery. This technique has provided up to 3 cm. of additional length without complication in 3 cases.

Anastomosis, Surgical↗
PubMed1992

Prophylactic and therapeutic carboprost tromethamine bladder irrigation in rats with cyclophosphamide-induced hemorrhagic cystitis.

Recently, prostaglandins have been shown to be effective agents for the treatment of cyclophosphamide-induced hemorrhagic cystitis. Among the prostaglandins studied is carboprost tromethamine, a PGF2a analog. To determine the effectiveness of carboprost tromethamine therapy on the urothelium, we induced hemorrhagic cystitis in 81 rats. These were divided into two treatment arms. One arm was treated prophylactically at the time of cyclophosphamide injection, and the other started treatment only after hemorrhagic cystitis was established. Animals were divided equally into groups receiving 0, 0.4, 0.8, and 1.6 mg.% carboprost tromethamine in 0.9% normal saline by continuous bladder irrigation. All bladders were examined grossly for edema and hemorrhage, then histologically for mucosal ulceration, congestion, and perivascular hemorrhage. Results from the prophylactic arm, as compared to those for controls, revealed that all groups except those treated only with 0.9% normal saline had a lower incidence of hemorrhagic cystitis (p less than 0.05). In the established hemorrhagic cystitis arm, the group treated with 1.6 mg.% carboprost tromethamine showed the best response (p less than 0.05), whereas the group treated with 0.9% normal saline showed the poorest response. This study reveals that hemorrhagic cystitis in the rat model may be prevented by prophylactic continuous bladder irrigation with carboprost tromethamine, whereas established hemorrhagic cystitis may be treated effectively with intravesical instillation of carboprost tromethamine. Although the mechanism of action of this prostaglandin on the urothelium is unknown, it appears grossly and histologically to decrease ulceration, perivascular hemorrhage, and congestion in the mucosa and submucosa.

Animals↗
PubMed1992

Large cell calcifying Sertoli cell tumor of the testis.

We report on a patient with a large cell calcifying Sertoli cell tumor of the testis and review the literature of this recently described rare subtype of Sertoli cell tumor. Twenty-one cases, including ours, have been reported in the literature. Six of twenty cases (28%) had clinically evident endocrine abnormalities and eight of twenty-one cases (38%) were bilateral. This tumor has a low malignant potential with only one patient known to have metastatic disease.

Calcinosis↗
PubMed1991

Pharmacological erection program using prostaglandin E1.

A total of 72 impotent patients entered into a pharmacological erection program using prostaglandin E1. Of the men 35 (49%) used prostaglandin E1 on a regular basis, while 37 (51%) failed to continue in the program beyond the in-office dose titration period. In patients who continue to use prostaglandin E1 the median duration of drug use is 7 months, with a range of 2 to 28 months. There have been no instances of cavernous fibrosis, systemic reaction or chemical priapism (erection present longer than 4 hours) in any patient. Only 8 men (11%) were unable to achieve an adequate erection with prostaglandin E1 injections. The most common adverse effect of prostaglandin E1 was penile pain after injection. The incidence of severe pain leading to drug discontinuation was 17% (12 of 72 patients) while mild to moderate pain occurred in 22% (16 of 72). Over-all, intracavernous prostaglandin E1 injections appear to be a safe, effective treatment for impotence in most men.

Alprostadil↗
PubMed1991

Extended inpatient treatment of a refractory heroin addict: a multidisciplinary approach to patients with a dual diagnosis.

Chemically dependent patients may also have a psychiatric problem (e.g., thought disorder, affective disturbance, character pathology). They may suffer as well from concomitant neurological deficits. Consequently, such patients are difficult to treat, and they tend to relapse after achieving sobriety in a short-term treatment program. Traditional chemical dependency programs thus may run the risk of oversimplifying the needs of these refractory patients. The authors present a clinical case to illustrate how an in-depth assessment and extended inpatient care by a multidisciplinary treatment team can achieve more lasting success with refractory dual-diagnosis patients.

Adult↗
PubMed1991

Penile duplex sonography in the diagnosis of venogenic impotence.

This study tested the hypothesis that measurements of cavernous arterial diastolic velocity and resistance index could provide a quantitative but noninvasive measure of penile corporal venous leakage. Seventy-four men were studied with duplex ultrasonography after intracavernosal injection of 60 mg of papaverine. Fourteen men had normal erection and served as controls. Sixty men had a 1-year history of transient fading or incomplete erections. In all subjects the peak systolic velocity and end-diastolic velocity were measured, and the resistance index was calculated (peak systolic velocity--end-diastolic velocity/peak systolic velocity). Men with normal erections had peak systolic velocities greater than 35 cm/sec and end-diastolic velocities less than 4.5 cm/sec (group 1). Patients with incomplete erections (group II) could be classified into three subgroups. Twenty-three patients with end-diastolic velocities greater than 4.5 cm/sec and normal peak systolic velocities greater than 35 cm/sec were suspected to have corporal venous leakage (group A). Eighteen patients had normal end-diastolic velocities less than 4.5 cm/sec. Twelve of this group had peak systolic velocities less than 35 cm/sec, and six had peak systolic velocities ranging from 37 to 44 cm/sec. These patients were suspected of having arterial insufficiency (group B). Fifteen patients with end-diastolic velocities greater than 4.5 cm and peak systolic velocities less than 35 cm were suspected of having both venous leakage and arterial insufficiency (group C). Twenty-one patients with abnormal diastolic flow underwent infusion pharmacocavernosometry to determine the saline maintenance infusion rate necessary to maintain an intracavernosal pressure of 90 to 100 mm Hg or a full erectile response.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Evaluation of carboprost tromethamine in the treatment of cyclophosphamide-induced hemorrhagic cystitis.

The treatment of cyclophosphamide-induced hemorrhagic cystitis has been difficult, with overall poor results using intensive and costly therapy. The authors evaluated the treatment of this problem in four patients with prostaglandin intravesical therapy. Each patient had failed to respond to conservative management. Carboprost tromethamine (Hemabate) was instilled into the bladder, with dwell times ranging from 45 to 60 minutes, three to four times a day for 4 to 5 days. Two of the patients required a second course with carboprost tromethamine at an increased concentration. A third patient's treatment was stopped after the first 5-day course because of intractable bladder spasms and persistent hematuria. In the three patients who completed the full course of therapy the hematuria resolved completely. The only side effect noted was bladder spasms, which were controlled in three of the four patients with oxybutynin chloride. This preliminary evaluation suggests that carboprost tromethamine may be a safe and effective bedside treatment of cyclophosphamide-induced hemorrhagic cystitis.

Adult↗
PubMed1988

Retroperitoneal actinomycosis: a case report and review of the literature.

A 25-year-old Haitian man presented with a post-traumatic left retroperitoneal abscess. Culture of material obtained during surgical drainage yielded Actinomyces israelii. Retroperitoneal actinomycosis is a particularly unusual manifestation of infection with this organism. Because it may mimic subacute infections or malignant masses in terms of clinical findings, diagnosis of this entity may be difficult. Our diagnosis was based on the results of culture, and the patient responded to long-term penicillin therapy.

Abscess↗
PubMed1988

Aspiration and tetracycline sclerotherapy of hydroceles.

Aspiration and sclerotherapy of hydroceles have been considered an effective outpatient procedure. We report on our experience with modification of this procedure in the treatment of 28 hydroceles. A 10 per cent solution of tetracycline hydrochloride was used as the sclerosant. In this series the mean followup was 15 months and there was an over-all 93 per cent success rate. A single treatment was successful in 75 per cent of the hydroceles. Complications included a hematoma in 2 patients and epididymitis in 1. We consider aspiration and sclerotherapy of hydroceles to be a reasonable alternative to an operation.

Adult↗
PubMed1987

Knowledge of AIDS among hospital workers: behavioral correlates and consequences.

Incidents of suboptimal care being rendered to AIDS patients have been documented. Using a voluntary anonymous questionnaire, we surveyed the employees of a large urban hospital in order to evaluate the knowledge, attitudes and professional behavior of the staff regarding AIDS. Responses were obtained from 1194 (60%) of the staff. Poor knowledge of the transmission of AIDS was documented, with 50% of workers stating that AIDS can be spread through ordinary non-sexual contact and 23% through the air by a cough or a sneeze. One-third of employees believed that they should be able to refuse to care for patients with AIDS. Extreme anxiety in dealing with AIDS patients was noted by 25% of employees, and only 16% of the employees would volunteer to work on an AIDS ward. Knowledge regarding AIDS was demonstrated to be a predictor of positive attitudes, appropriate professional behavior and lower anxiety in dealing with AIDS patients. The goal of hospital education programs on AIDS must be to ensure the incorporation of accurate information into the belief system of workers.

Acquired Immunodeficiency Syndrome↗
PubMed1985

High-grade malignancies of the parotid gland: effective use of planned combined surgery and irradiation.

The trend toward treatment of parotid gland malignancies with planned combined surgery and postoperative radiation therapy is currently being followed by many centers, although prospective studies confirming the efficacy of this treatment regimen have only recently begun. We have reviewed only our "high-grade" histologic types: adenocarcinomas, malignant mixed tumors, high-grade mucoepidermoid carcinomas, squamous cell carcinomas, and undifferentiated carcinomas. Acinic cell carcinomas, adenoid cystic carcinomas, and low-grade mucoepidermoid carcinomas were excluded from study because of their different biologic behavior. Since 1974, we have employed the approach of surgical extirpation with preservation of the facial nerve when possible for all parotid tumors, combined with planned postoperative radiation therapy (50-70 Gy). We reviewed the 37 cases of "high-grade" parotid gland malignancies and compared the patients treated with the combined modality approach with our historical patients treated initially with surgery alone. Despite an apparent higher stage at presentation, our combined treatment group ultimately had significantly better local control (70% vs. 20%), and an equivalent survival rate at five years. Tumor was present at the margin of resection in 14 (74%) cases treated with combined surgery and irradiation. The facial nerve was preserved in six of these patients with positive margins, and only one of these patients developed a local or regional treatment failure. In conclusion, our data confirms the efficacy of surgical exploration to determine the extent of disease and surgical resection, preserving facial nerve function if possible, followed by postoperative radiation therapy at adequate doses. Control of local-regional disease was much improved by combined modality therapy as opposed to surgical resection alone, despite the prevalence of residual microscopic disease in the resection margins. Facial nerve function is optimally preserved by this approach of conservative surgery combined with postoperative radiation therapy.

Adenocarcinoma↗
PubMed1979

Agnogenic myeloid metaplasia with a parotid mass.

Agnogenic myeloid metaplasia, one of the entities in the myeloproliferative syndrome, usually initially appears with splenomegaly, hepatomegaly, and a normocytic, normochromic anemia. Extramedullary hematopoiesis is also a common finding, but is exceedingly rare in the major salivary glands. We report a case of extramedullary hematopoiesis in the parotid gland and discuss the differential diagnosis and characteristics of the disease.

Aged↗
PubMed1979

Flap reconstruction in patients with head and neck cancer: techniques and results.

Patients who are treated by surgery, radiotherapy, or any combination thereof may suffer from complications in wound healing or tumor recurrence which necessitate reconstruction of repair utilizing tissue brought in from other parts of the body. The majority of patients, who required flap reconstruction for primary repair or for a complication of their surgery, had their primary lesion in the supraglottic larynx or inferior hypopharynx. More than two-thirds of the flaps elevated were for fistula repair. Five year survival in this group of patients was lower than in those patients with uncomplicated postoperative courses, although the quality of life for the survivors in both groups was not significantly different.

Adult↗