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Biomedical subjects

M L Levy

Publications and source records attributed to M L Levy.

At least 127 records · Page 7Linked to original sources
PubMed1993

Subcutaneous fat necrosis of the newborn and hypercalcemia: case report and review of the literature.

Subcutaneous fat necrosis of the newborn (SCFN) alone is an uncommon condition. Its association with hypercalcemia has been reported in 19 neonates since 1926. The two occur in full-term to postterm newborns with perinatal complications associated with delivery. Erythematous to violaceous, firm, subcutaneous nodules appear approximately 1 to 4 weeks after delivery, preceding the development of signs and symptoms of hypercalcemia. Although SCFN and hypercalcemia are rare complications in neonates with perinatal problems, death due to the sequelae of hypercalcemia occurred in 3 of the 19 patients. A neonate who develops skin lesions consistent with SCFN should be followed for possible onset of hypercalcemia and treated in a timely fashion.

Fat Necrosis↗
PubMed1993

The significance of subarachnoid hemorrhage after penetrating craniocerebral injury: correlations with angiography and outcome in a civilian population.

Certain clinical factors are considered to have an effect on patient outcome after penetrating missile injury. These include bilateral hemispheric injury, ventricular hemorrhage, intracerebral hemorrhage, mass effect, and missile or bony fragmentation. The relationship of subarachnoid hemorrhage (SAH) after penetrating craniocerebral injury and outcome is unknown. In addition, controversy exists regarding the role of angiography and the incidence of traumatic intracranial aneurysm in this population. Finally, can we assume that the incidence of traumatic intracranial aneurysm is equal in military and civilian populations, given the absence of penetrating shrapnel injury in civilian populations? Now that computed tomography has supplanted angiography as the primary diagnostic modality, increasing vigilance on the part of the physician and examination of angiography in high-risk patients should allow for enhanced outcome. We evaluated 100 patients with a diagnosis of cerebral gunshot wound over a 12-month period. All patients were evaluated neurologically at the time of admission and had imaging studies. Thirty-one patients with radiological evidence of SAH on computed tomography underwent angiography. Angiograms were limited to the side of the injury in patients with single-lobe or unilateral multilobe injuries and were bilateral in patients with bilateral hemispheric involvement. One intracranial aneurysm (3.2%) was documented and treated surgically. In those patients who died within 48 hours of admission, 68% had SAH as compared with only 17% of those surviving. Outcome was based upon neurological evaluation at the time of discharge and at the time of clinical follow-up at 3 and 6 months.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

Penetrating craniocerebral injury resultant from gunshot wounds: gang-related injury in children and adolescents.

We prospectively and retrospectively reviewed a series of 780 patients who presented to the University of Southern California/Los Angeles County Medical Center with a diagnosis of gunshot wound to the brain during an 8-year period. Of these, 105 were children ranging in age from 6 months to 17 years. Injuries were gang related in 76 (72%) children and adolescents. Stepwise linear regression analysis was used to formulate a predictive model of outcome in this population. Patient age (F = 10.92), sex (F = 9.32), occipital entry site (F = 8.17), bihemispheric injury (F = 8.50), and admission Glasgow Coma Scale (F = 69.91) were all found to correlate with outcome (P < 0.05). Significant differences between pediatric and adult populations were noted in transit time, entrance site, and age-related outcome. Occipital or assassination-type wounds were most common in children. In addition, a younger age was associated with poor outcome (P < 0.0001). We describe both the economic and racial trends in our population of patients in addition to weapon type and toxicological evaluation. The Department of Neurological Surgery is becoming directly involved in providing information to children at the junior high school level regarding gang activity and brain and spinal cord injury. In conjunction with the Community Youth Gang Services Organization and Think First Organization, we are attempting to integrate prevention through education and community mobilization. This is a plan aimed at informing and recovering the youth affected by gangs.

Adolescent↗
PubMed1993

Cardiac performance enhancement from dobutamine in patients refractory to hypervolemic therapy for cerebral vasospasm.

The use of the beta-agonist dobutamine in combination with hypervolemic preload enhancement of cardiac performance was analyzed in 23 patients who failed to respond to traditional preload enhancement following aneurysmal subarachnoid hemorrhage. The patients ranged in age from 13 to 82 years, and three had a history of cardiac disease. Each patient underwent placement of a flow-directed balloon-tipped catheter and the following measurements were obtained during hyperdynamic therapy: pulmonary artery wedge pressure, central venous pressure, cardiac index, stroke volume index, total peripheral resistance, and left ventricular stroke work index (LVSWI). Mean baseline cardiac function was found to be within normal limits (LVSWI = 47.6 +/- 4.2 gm/min/sq m and cardiac index = 3.30 +/- 0.22 liter/min/sq m). After baseline measurements were recorded, 5% albumin was infused at 300 cc/hr and dobutamine was initiated at a rate of 5 to 10 micrograms/kg/hr. This hyperdynamic therapy with dobutamine in the presence of volume loading resulted in a 52% increase in cardiac index, a 15% increase in LVSWI, and a 21% decrease in total peripheral resistance. The clinical reversal of ischemic symptoms due to subarachnoid hemorrhage was evident in 18 (78%) of the 23 patients.

Adolescent↗
PubMed1993

Subdural empyema of the cervical spine: clinicopathological correlates and magnetic resonance imaging. Report of three cases.

A paucity of formally described information is available in the scientific literature regarding spinal subdural empyema. Patients presenting with neurological deterioration associated with subdural empyema are rarely identified, and treatment is often based upon anecdotal cases. The authors contribute three cases of primary cervical spinal subdural empyema and review the seven found in the literature. All patients had clinical evidence of neurological compromise, cervical tenderness, cervical pain, and leukocytosis upon admission. Cervical involvement ranged from C-2 to C-7. All patients underwent laminectomy with durotomy and drainage. The authors recommend prompt surgical decompressive laminectomy, copious irrigation, and drainage, followed with appropriate adjunctive antibiotic therapy for treatment of these patients.

Adult↗
PubMed1993

Nonepidermal and appendageal skin tumors.

This article reviews the essential clinical and pathologic features of a number of tumors of the dermis and epidermal appendages to help improve the clinician's skill at formulating preoperative differential diagnoses, assessing the need for treatment, and determining appropriate follow-up. In addition, it attempts to alert the practitioner to a number of heritable and systemic conditions that may be signalled by the presence of cutaneous tumors.

Adolescent↗
PubMed1993

The ringworm riddle: an outbreak of Microsporum canis in the nursery.

Tinea capitis, the most common fungal infection in children, is rare in neonates. We report six patients in a Level II intermediate care nursery who developed nosocomial dermatophyte infections caused by Microsporum canis. The investigation, which led to the identification of a nurse as the common source, is described. The nurse had an indolent infection with M. canis. Human to human transmission is exceedingly rare for M. canis. The literature regarding neonatal dermatophyte infections is discussed in relation to the reported outbreak.

Antifungal Agents↗
PubMed1992

Radionecrosis secondary to interstitial brachytherapy: correlation of magnetic resonance imaging and histopathology.

Radiation-induced tissue damage in the central nervous system is a well-known complication of interstitial brachytherapy for brain tumors, yet imaging correlates have historically been based upon computed tomographic scans. We now present magnetic resonance imaging (MRI) to correlate radiation changes after interstitial brachytherapy with the histopathology. The central nervous system of a 38-year-old man with a left frontal cerebral glioma diagnosed by stereotactic biopsy was treated with interstitial brachytherapy (iridium-192, 47 Gy), followed by limited-field irradiation (45 Gy). With progressive deterioration, a second biopsy demonstrated radiation changes. Despite aggressive medical management, the patient died 9 months after completion of radiation therapy. Postmortem evaluation compared MRI scans of the intact, fixed brain with the histopathology. Axial sections (10 mm) obtained by MRI scan and autopsy brain slices were cut in the identical plane. Neuroimaging and histopathological findings of the lesion correlated within 2 to 3 mm resolution. In the peripheral white matter, MRI scan did not indicate the extent of radiation effect histologically. We suggest that MRI has limited utility in assessing the extent of impact of radiation on surrounding brain.

Adult↗
PubMed1992

Magnetic resonance imaging and pathological correlates of meningiomas.

We examined the relationships between specific magnetic resonance imaging features and certain gross and microscopic characteristics of meningiomas, including vascularity, gross texture (consistency), and venous sinus involvement. Magnetic resonance imaging scans, surgery reports, and the histopathological findings of tumors were examined retrospectively in 54 patients. Sinus involvement was accurately predicted on T1-weighted images in 9 of 10 cases (P = 0.001) and tumors with cystic changes in 3 of 3 cases. T1-weighted images were not useful for predicting vascularity unless actual flow voids could be visualized (five of six cases). There was no correlation between T1 signal intensity, tumor consistency, or histological findings. In tumors without detectable vascularity on T1-weighted images, hyperintensity relative to gray matter on T2-weighted images was correlated with increased vascularity (P = 0.004). Tumors with soft consistency (P = 0.007), cellular atypia, invasion, angioblastic, or melanocytic components were also hyperintense, compared with gray matter on T2-weighted images (P = 0.0266). Aggressive meningiomas were found to be more vascular (P = 0.045). No correlation was found between the degree of surrounding edema or contrast enhancement with histopathological findings, vascularity, or consistency.

Brain↗
PubMed1991

A controlled trial of acyclovir for chickenpox in normal children.

BACKGROUND: Chickenpox, the primary infection caused by the varicella-zoster virus, affects more than 3 million children a year in the United States. Although usually self-limited, chickenpox can cause prolonged discomfort and is associated with infrequent but serious complications. METHODS: To evaluate the effectiveness of acyclovir for the treatment of chickenpox, we conducted a multicenter, double-blind, placebo-controlled study involving 815 healthy children 2 to 12 years old who contracted chickenpox. Treatment with acyclovir was begun within the first 24 hours of rash and was administered by the oral route in a dose of 20 mg per kilogram of body weight four times daily for five days. RESULTS: The children treated with acyclovir had fewer varicella lesions than those given placebo (mean number, 294 vs 347; P less than 0.001), and a smaller proportion of them had more than 500 lesions (21 percent, as compared with 38 percent with placebo; P less than 0.001). In over 95 percent of the recipients of acyclovir no new lesions formed after day 3, whereas new lesions were forming in 20 percent of the placebo recipients on day 6 or later. The recipients of acyclovir also had accelerated progression to the crusted and healed stages, less itching, and fewer residual lesions after 28 days. In the children treated with acyclovir the duration of fever and constitutional symptoms was limited to three to four days, whereas in 20 percent of the children given placebo illness lasted more than four days. There was no significant difference between groups in the distribution of 11 disease complications (10 bacterial skin infections and 1 case of transient cerebellar ataxia). Acyclovir was well tolerated, and there was no significant difference between groups in the titers of antibodies against varicella-zoster virus. CONCLUSIONS: Acyclovir is a safe treatment that reduces the duration and severity of chickenpox in normal children when therapy is initiated during the first 24 hours of rash. Whether treatment with acyclovir can reduce the rare, serious complications of chickenpox remains uncertain.

Acyclovir↗
PubMed1991

Surgical strategies and technical methodologies in optimal management of craniopharyngioma and masses affecting the third ventricular chamber.

Management of craniopharyngiomas and masses affecting the third ventricular chamber represents one of the most challenging problems confronting contemporary neurological surgeons. Given the devastating sequelae of surgical complications involved in approaches to the deep cerebral midline, surgical management requires a combination of sophisticated imaging, diagnostic pathology and surgical technique including ventricular microsurgery and stereotaxy and its attendant refinements. Surgical and non-surgical management is based upon the structural presentation of these masses as defined by detailed imaging studies. Operative objectives include histological definition, maximally feasible excision, cerebral spinal fluid diversion and relief of neurologic deficits created by masses affecting the third ventricular chamber.

Cerebral Ventricle Neoplasms↗
PubMed1991

Disorders of the hair and scalp in children.

A wide variety of disorders involving the scalp and hair exist that may be encountered in the pediatric and adolescent population. An approach to the differential diagnosis of many of these conditions can be considered once the patient is found to have either alopecia, scaling, or tumors of the scalp. Certainly other causes of scalp or hair disease exist but the more common disorders can be appropriately considered in this manner.

Alopecia↗