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Biomedical subjects

L F Levy

Publications and source records attributed to L F Levy.

At least 19 recordsLinked to original sources

Infection after Harare valve V-P shunt operations: a review of 92 cases.

Case files of 92 patients who had their hydrocephalus relieved by the insertion of the Harare Valve shunt system were reviewed. All patients had undergone surgery for shunt insertion at the Harare Central and Parirenyatwa Teaching Hospitals in Harare, Zimbabwe, between January 1986 and January 1988. All but one patient reviewed had Harare valve ventriculoperitoneal shunt insertions. The commonest indication for shunt insertion was congenital hydrocephalus alone or coexisting with other abnormalities (62 pc). Post meningitic hydrocephalus and hydrocephalus associated with intracranial tumours were next in frequency at 26 pc and 9 pc respectively. The etiology of hydrocephalus was not diagnosed in one four-year-old patient. The ages of the patients on admission ranged from one day to seven years (mean 12.4 months). Infection rates correlated well with the etiology of hydrocephalus; lowest (2 and half pc) in patients with simple congenital hydrocephalus and highest (29.2 pc) in post meningitic patients. A variety of organisms were isolated from CSF, blood, wounds and catheter tips. Lactose fermenting coliforms, S. epidermidis and E. coli predominated. Infection was combated by antibiotics, shunt removal or a combination of both. The antibiotics most commonly used were the penicillins, chloramphenicol, cloxacillin and gentamycin.

Anti-Bacterial Agents

Epilepsy.

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Africa

Anterior encephalocoele--our experience in Harare, Zimbabwe, after the introduction of cat scanning.

A series of eight anterior encephalocoeles is reported. The ratio of anterio to occipital encephalocoeles is high compared to the European series and similar to one from South Africa. These have been studied by CT Scan which has shown the exact anatomy of these abnormalities previously unclear to us. The precise information obtained serves to provide a better planned surgical procedure with better results and reduced operating time and morbidity.

Child, Preschool

The technique of fetal electroencephalography during labour.

A method for recording the fetal electroencephalogram (EEG) during labour is described. Technical specifications for the construction of a suitable electrode are detailed. One hundred and twenty-three patients in labour were monitored using this technique and the success rate of obtaining records for analysis was 91 per cent.

Brain

Chronic cerebellar stimulation in the treatment of epilepsy.

Six cases of intractable epilepsy who were subjected to chronic cerebellar stimulation are reported. They had all been treated with a wide range of anticonvulsant drugs without success. The ages varied between 17 and 55 years. Three were genetic-inherent, 2 were of unknown etiology, and 1 was symptomatic (infection? trauma?). Four had generalized major convulsions and 2 had a mixture of major and minor attacks, 1 with a strong temporal lobe component. Stimulation was commenced in all cases as soon as the patients had a postoperative seizure. Headache occurred in all cases and necessitated reduction in the strength of the stimulation to between 2 and 4 V in all cases except 1. Occipital nerve block temporarily relieved 1 patient, but posterior root section of C2-C3 and part of C4 did not prevent headaches in another case. Two patients were greatly improved and managed to hold employment whereas formerly they had been unemployed. One patient felt 50% improved but there was no reduction in his seizure frequency; another had a 50% reduction in seizures but felt no better. One patient was noted to be improved intellectually although her seizures were more frequent. The remaining patient was unchanged. One patient committed suicide and another drowned. One prosthesis became infected and had to be removed.

Adolescent

Congenital inclusion dermoid cyst of the anterior fontanel.

An unusual type of dermoid cyst is reported in 10 African infants. In these cases a soft, cystic mass located over the anterior fontanel was noted shortly after birth and gradually enlarged. The cyst had no intracranial extension and was easily excised intact. The clinical and x-ray findings of the cyst are described and compared with the usual dermoids. The histology and the contents of the cyst are detailed and some peculiarities of this lesion pointed out.

Dermoid Cyst

Primary cerebral neoplasia in Rhodesia.

In 17 years we have performed 6,505 neurosurgical procedures in the neurosurgical unit of the Salisbury Hospital Group. Only 62% were performed on Africanpatients and 38% on European patients, despite the fact that the African population exceeds the European population by 20 times. This is partly due to the tolerance of rural people towards disease and partly to a number of social factors. The European group has a greater percentage of elderly people than the African group and, although we could not estimate the incidence of tumors among the African group, we would expect their overall incidence per capita to be lower because malignant tumors tend to occur in older people. We do not suspect the existence of a genetic factor in tumor incidence. There were 205 primary intracranial neoplasms in Africans and 244 in Europeans. Histological study shows that 33% of all tumors were meningiomas in the African group compared to 19% in the European group. Gliomas comprised 61.3% of the European series and 48.8% of the African series but the distribution by Kernohan's grading of astrocytomas was the same in both groups. If age was a factor, Grades I and II should have predominated in the African group, but did not. The incidence for each tumor among our European patients followed the patterns reported in various European and USA series. Likewise the pattern emerging from our African series closely paralleled the reports of other workers in Africa. Acoustic neuromas appear to be rather rare among Africans. The average age of all adults with tumors was 15 years lower in the African group than in the European group. However, this is entirely related to the age structure of the population, and not to an earlier age of occurrence. The average ages of medulloblastoma cases were identical. In our European series the occurrence according to age was much the same as that reported by overseas workers. The sex incidence of tumors in the European group seems to be a fair reflection of the situation elsewhere; in the African group it is questionable because men go into the towns to work and leave their families in the country. There was no significant difference in the location of tumors in the two groups. Results of treatment were uniformly inferior in the African group, partly due to the lateness of arrival at the hospital so that the growth was already far advanced and also because many patients suffered poor health from concomitant disease.

Adolescent