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Biomedical subjects

P A Levine

Publications and source records attributed to P A Levine.

11 recordsLinked to original sources
PubMed1992

Neurological deterioration after lumbar cerebrospinal fluid drainage.

Large-bore lumbar spinal fluid drainage is used frequently as part of the preoperative and intraoperative management of patients undergoing cranial base tumor resection. Such drainage allows displacement of the brain with minimal force, thereby potentially decreasing retraction damage to it. We document 2 patients in whom serious complications resulted from lumbar drainage systems. These patients deteriorated into a coma state following cerebrospinal fluid (CSF) drainage. Reinfusion of synthetic CSF solutions caused a brisk return to normal neurological status. These plus other potential complications associated with lumbar drainage, such as persistent CSF leaks into the back and soft-tissue nerve root injury, warranted abandoning the lumbar cistern drainage route of CSF drainage in favor of drainage directly from the intracranial compartment. Depending on the particular operation performed, drainage of CSF near the cribriform plate, the suprachiasmatic cistern, or from the sylvian fissure may be effective sites for CSF drainage. Unlike lumbar drainage, intracranial CSF drainage does not have the added risk of promoting cerebral herniation.

Carcinoma, Squamous Cell↗
PubMed1992

The serratus anterior free tissue transfer for craniofacial reconstruction.

The serratus anterior muscle was used as a free tissue transfer to reconstruct complex craniofacial defects in 5 patients. Serratus anterior muscle alone and serratus anterior muscle with rib were the transfers made. All flaps survived and scapular winging did not occur. The serratus anterior muscle has several advantages for the reconstruction of medium-sized craniofacial defects. Because of its position, a two-team approach is possible. It has a consistent pedicle anatomy and low donor site morbidity. It has a large caliber vessel and a long pedicle. When compared with the commonly employed rectus abdominis flap for moderate-sized defects, the serratus muscle offers greater versatility in design and has the option of incorporating bone and innervated muscle without increasing significant donor site morbidity.

Adolescent↗
PubMed1992

Comparison of intrinsic versus paced ventricular function.

UNLABELLED: There is increasing evidence supporting the benefits of providing optimum AV delay in cardiac pacing, though controversy exists regarding its value and the benefits of intrinsic versus paced ventricular activation. This study compared various AV delays at rest in patients whose native AV delays were > or = 200 msec. Only patients with DDD pacemakers who had intact AV conduction and normal ventricular activation were included in the study. Nine patients were studied. METHODS: Ten studies were performed. Evaluation was done in AAI and DDD modes at paced heart rates of 60/min or as close as possible to the intrinsic heart rate if this was > 60/min. Stroke volume (SV) and cardiac output (CO) were measured. RESULTS: When AV sequential pacing in the DDD mode with an optimum AV delay was compared to AAI pacing with a prolonged AV interval, the average optimum AV delay in the DDD mode was 157 msec and ranged from 125 to 175 msec. The average AV interval in the AAI mode was 245 msec and ranged from 212 to 300 msec. In the DDD mode, there was an overall significant improvement in CO of 11% and SV of 9%. Patients with intrinsic AV conduction times of > 220 msec showed an overall significant improvement in CO of 13% and SV of 11%. In patients with intrinsic AV conduction times of < 220 msec, an improvement in CO of 6% and SV of 4% was seen. CONCLUSIONS: (1) An optimum AV delay is an important component of hemodynamic performance; and (2) AV sequential pacing at rest with an optimum AV delay may provide better hemodynamic performance than atrial pacing with intrinsic ventricular conduction when native AV conduction is prolonged > 220 msec.

Aged↗
PubMed1978

The long tracheostomy tube. Alternative management of distal tracheal stenosis.

The incidence of tracheal strictures has greatly increased, and even in the most controlled clinical setting, the treatment of this problem requires sophisticated surgical management. We present an alternative method of management that was initially used to secure a temporary airway in young and debilitated patients. This technique has provided both immediate relief of the airway obstruction and definitive long-term correction of the stenosis, with a low complication rate.

Adult↗
PubMed1978

Trifascicular and complete heart block with anterior myocardial infarction. Electrocardiographic patterns and long-term medical management.

A 45-year-old man exhibited various patterns of delay in trifascicular conduction, culminating in complete heart block during acute myocardial infarction. A temporary pacemaker was utilized for the short period of heart block. Delay in ventricular conduction subsided, and the patient refused implantation of a permanent pacemaker. Ventricular irritability, which was detected eight months later, was suppressed with administration of digitalis, guided by testing with acetylstrophanthidin. Neither heart block nor delay in ventricular conduction recurred during 43 months after the infarction. In certain patients with heart block complicating anterior myocardial infarction, long-term prognosis may be dictated by coronary and myocardial residual function, rather than by the hazard of recurrent heart block.

Bundle-Branch Block↗
PubMed1978

Fracture of pacing electrode mimicking failure of pulse generator.

To our knowledge, this is the first reported case of spontaneous fracture of a pacing electrode with decreased amplitude of the pacing artifact, failure to capture, and intact sensing. We postulate that the difference in impedance of the pacemaker for sensing and stimulation may account for this phenomenon.

Aged↗
PubMed1977

Postnatal descent of the epiglottis in man. A preliminary report.

The function of the epiglottis in adult man is unclear. However, during early infancy the epiglottic cartilage appears to play an important role in separating the upper respiratory tract from the upper digestive tract. This separation is accomplished by approximation of the epiglottis to the palate, providing a continuous airway from the nose through the larynx into the trachea. This structural arrangement, however, is uniquely lost in man during postnatal development. Maturational descent of the epiglottis, found to occur between 4 and 6 months of age, is verified by cineradiography. This structural change, requiring a reorganization of respiratory function, represents a discrete developmental event manifesting the potential for oral tidal respiration from a pattern of obligate nasal breathing. This period, four to six months postnatally, interestingly coincides with the peak incidence of sudden infant death syndrome (crib death), which similarly occurs at 3 to 5 months of age.

Aging↗
PubMed1976

Mechanisms of arrhythmias in chronic obstructive lung disease.

Because of the close anatomic and physiologic relationship between the heart and lungs, patients with chronic obstructive lung disease are at special risk of arrhythmias. Effective therapy hinges on identifying the mechanisms of the arrhythmias--hemodynamic, metabolic, or drug-induced. Impulsive use of antiarrhythmic agents may result only in a more complex and dangerous rhythm disorder. Extremes of pH are a major cause of arrhythmias in these patients. Respiratory alkalemia usually originates with inappropriate ventilation, often during mechanical respiration, while metabolic alkalemia generally can be traced to diuretic or bicarbonate therapy. Lidocaine or diphenylhydantoin are of little use, since the alkaline pH inside and outside heart muscle cells hampers drug distribution and activity. At the other extreme, the arrhythmias of acidemia strike patients who have severe respiratory failure with carbon dioxide retention or severe cardiac failure with shock and lactic acidemia. Arrhythmias may develop if vagal restraint is lost, which is especially likely in patients with potassium depletion. Irritant receptors along the bronchopulmonary tree can trigger arrhythmias if stimulated by cough, microembolism, or mechanical irritation, which is a hazard with endotracheal or tracheostomy tubes.

Aged↗