Biomedical subjects

R M Levinson

Publications and source records attributed to R M Levinson.

At least 19 recordsLinked to original sources

PubMed1998

Evaluation of the microbiology of chronic maxillary sinusitis.

Chronic paranasal sinusitis is a disease that afflicts a significant percentage of the population and causes considerable long-term morbidity. With the common use of multiple courses of broad-spectrum oral antibiotics to treat this condition, there is a possibility of an alteration in the pathogens that promote a persistence of chronic sinusitis. One hundred seventy-four consecutive patients with a diagnosis of chronic maxillary sinusitis requiring an endoscopic surgical procedure were prospectively evaluated. At the time of surgery, cultures of mucopus in the maxillary sinus were aseptically obtained endoscopically and cultured for aerobes, anaerobes, and fungus. Two hundred seventeen isolates from 174 patients were obtained. Coagulase-negative staphylococci were the most common isolates (36%), followed by Staphylococcus aureus (25%), Streptococcus viridans (8.3%), Corynebacterium (4.6%), and anaerobes (6.4%). Although coagulase-negative Staphylococcus is not considered a pathogen, of the 24 isolates that had sensitivity testing performed, 13 demonstrated resistance to multiple antibiotics, including cephalothin, erythromycin, oxacillin, sulfonamides, and clindamycin. This study demonstrates that aerobic rather than anaerobic bacteria are the more common pathogens in chronic sinusitis. In addition, coagulase-negative Staphylococcus may be a pathogen in the disease process, and sensitivities should be obtained of this isolate for evaluation and possible treatment.

Adult↗

PubMed1996

Nurse practitioners' reactions to persons with HIV/AIDS: the role of patient contact and education.

Attitudes about caring for patients with HIV/AIDS (PWAs) were investigated in a survey mailed to all nurse practitioners (NPs) in Georgia. There was a 53% response rate to the survey (286 of 539 questionnaires were returned). It was hypothesized that exposure to continuing education on HIV/AIDS and to HIV-positive patients would be associated with more positive attitudes and less extreme behavioral changes associated with fear of transmission. Factor analytic procedures were used to generate three scales: resentment of PWAs (RESENT), anxiety or fear about contact with PWAs (FEELINGS), and changes in personal life related to fear of transmission after contact with PWAs (CHANGE). Descriptive findings indicated that a significant minority of NPs were worried about risk, harbored some resentment toward PWAs, and had changed their behavior out of concern about the possible transmission of HIV. Differences of means and stepwise regression analyses (with several potentially confounding variables controlled) found exposure to continuing education associated with less fear and anxiety, less resentment, and less behavioral change. Exposure to HIV-positive patients was associated with less behavioral change, as predicted, but not with less fear/anxiety or resentment. The cross-sectional survey design limits the attribution of causality, but offers some support for the role of continuing education in improving attitudes toward PWAs.

Acquired Immunodeficiency Syndrome↗

PubMed1992

Living arrangements, knowledge of health risks, and stress as determinants of health-risk behavior among college students.

The association of knowledge of health risks, living arrangements, and perceived stress with health-risk behaviors was examined in a sample of college students included in the Health Promotion and Disease Prevention Supplement of the National Health Interview Survey. Regressions of each health-risk behavior (dependent variable) were performed on the predicted correlates. Although knowledge was not associated with participation in physical activity or smoking, the study found that students who knew more about the harmful effects of alcohol drank less, and those with greater knowledge of health risks practiced fewer risky behaviors. Students living independently were more likely to smoke, and those living in residence halls were less like to do so. Drinking, however, was more common among students living in residence halls or independently than among those living at home. Hall residents engaged in more group physical activity than other students did, but their physical activity was unrelated to health-risk behaviors. Stress was associated with smoking but not with other health practices. The findings suggest that smoking may be less influenced by health knowledge and more associated than drinking is with a response to stress. Drinking appears to be a social activity associated with living among peers and is potentially modifiable by increased knowledge about the effects of alcohol on health.

Adolescent↗

PubMed1990

Transoral labiomandibular approach to basiocciput chordomas in childhood.

Many excellent reports have dealt with the various aspects of cranial chordoma. It remains a relatively rare neoplasm, particularly in younger children. The authors have had the opportunity to treat a 5-year-old child harboring a basiocciput chordoma. It extended from the mid-clivus to C3. A transoral labiomandibular approach was used, allowing its resection. No evidence of recurrence was noted 3 years later. A literature search confirmed the rarity of basiocciput chordoma in young children. The perioperative difficulties encountered prompted this report.

Child, Preschool↗

PubMed1990

Health risk factors among the Amish: results of a survey.

The Amish are a unique societal subgroup deliberately setting themselves apart from the modern world through religious beliefs and practices. Few reports and no systematic studies have been conducted on Amish health behaviors. A representative sample of 400 Amish adults residing in Holmes County, Ohio, were interviewed using the Behavioral Risk Factor Survey (BRFS). For comparison, a representative sample of 773 non-Amish adults responded to the same survey through telephone interviews. Prevalence of self-reported hypertension was lower among Amish than non-Amish, obesity was greater among Amish than non-Amish women but similar among men, and stress responses were more prevalent among Amish than non-Amish. While some differences between groups could be influenced by response biases, many are supported by less systematic observations of Old Order Amish societies. Patterns of health behavior reflect characteristics of Amish culture and may be responsible for certain favorable mortality rates among the Amish population. Need for cultural sensitivity is evident in health promotion program design and implementation.

Adolescent↗

PubMed1988

Statutory change and 'street-level' implementation of psychiatric commitment.

This paper assesses the impact of a statutory change in psychiatric commitment laws on the dangerousness of involuntarily committed civil patients in one metropolitan area. More restrictive local guidelines for commitment emphasizing assaultiveness were replaced by a new state law which expanded the criteria to those whose health might deteriorate from neglect. Using an interrupted time-series analysis, we find that changes in the proportion of persons hospitalized as dangerous (or assaultive) occurred more among normally less assaultive groups such as older, white and female patients than among normally more assaultive categories of younger, black and male patients. The less assaultive groups contained an increasing proportion of dangerous patients under the period of restrictive guidelines but the proportion dropped dramatically following the implementation of the less restrictive law. Groups typified by higher rates of assaultiveness remained at a relatively high level, unaffected by changes in the statutes or time. Given the relative stability in the numbers of OTA patients committed over time, the results suggest that changes in the proportion of patients said to be dangerous may be an artifact of the way petitioners for patients and providers make use of the mental health system.

Adult↗

PubMed1987

Carcinoid tumors of the middle ear.

Carcinoid tumors of the middle ear are rare, with only three previously reported cases. The authors report the light and electron microscopic and immunohistochemical features of two carcinoid tumors that occurred in a 34-year-old female and a 21-year-old male. Both presented with unilateral hearing loss. By light microscopic examination, both were characterized by trabecula of tall columnar cells with basal nuclei and no mitotic activity. Electron microscopic examination demonstrated large numbers of pleomorphic neurosecretory granules, perinuclear aggregates of intermediate filaments, cell junctions, and surface microvillous processes. Some cells contained intermediate filaments forming tonofilaments and lacked secretory granules. These cells stained for cytokeratin by immunoperoxidase and separated the neuroendocrine cells from the underlying basal lamina. The cells in this tumor stained for the molluscan cardioexcitatory peptide. Cells in both tumors also stained for pancreatic polypeptide. Neither case stained for lysozyme, insulin, glucagon, somatastatin, gastrin, substance P, thyroid-stimulating hormone, adrenocorticotropic hormone, Met-enkephalin, Leu-enkephalin, neuropeptide Y, peptide YY, neurotensin, Bombesin, serotonin, neuron-specific enolose, glial and neural filaments, S-100 protein, cholecystokinin, beta-endorphin, beta-human chorionic gonadotropin, luteinizing hormone/follicle-stimulating hormone, vasoactive intestinal polypeptide, prolactin or calcitonin. Carcinoid tumor of the middle ear can be distinguished from paraganglioma and middle ear adenoma.

Adult↗

PubMed1987

Cartilage-perichondrial composite graft tympanoplasty in the treatment of posterior marginal and attic retraction pockets.

The atelectatic retraction pocket (ARP) has been implicated in the development of chronic otitis media and cholesteatoma. The ARP's tendency for persistence or recurrence despite treatment is a significant otologic problem. The purpose of this study is to define and discuss this clinical entity and the use of cartilage-perichondrium tympanoplasty as a safe and predictable method of treatment, reducing destructive complications while maintaining ear function. A retrospective analysis of 85 operated ears is presented.

Ear Cartilage↗

PubMed1986

Reperfusion pulmonary edema after pulmonary artery thromboendarterectomy.

Pulmonary artery thromboendarterectomy (PAT) is a potentially curative procedure in chronic, major vessel thromboembolic pulmonary hypertension. However, postoperative reperfusion pulmonary edema (RPE) has been a serious complication, often requiring prolonged mechanical ventilation. This entity has been described only anecdotally in the past. To characterize it more fully, we retrospectively analyzed the course and potential determinants of RPE after thromboendarterectomy in 22 patients who had PAT at our institution from 1969 through 1984. Particular attention was directed to clinical data, thrombus location, areas operated, postoperative roentgenograms, and preoperative and postoperative hemodynamic data. In all patients but 1, RPE developed within 72 h after surgery, corresponding to anatomic locations distal to vessels subjected to PAT. Regions of lung not reperfused at surgery were uniformly spared. Pulmonary capillary wedge and/or left atrial pressures preoperatively and postoperatively were not elevated. None of the preoperative data predicted which patients would develop more persistent RPE. These observations suggest that the phenomenon of RPE is a peculiar, focal form of pulmonary edema, the basis for which remains to be defined.

Adult↗

PubMed1984

Cross-cultural variations in the definition of child abuse: nurses in the United States and the United Kingdom.

As a form of social deviance, child abuse is subject to the definitions of various audiences rather than being intrinsic to the act. What is termed abuse varies between cultures, subcultures, etc. An exploratory study investigates similarities and differences in the definition of abuse among a sample of pediatric nurses in two U.S. (N = 18) and two U.K. (N = 34) hospitals. A questionnaire asked respondents to indicate whether they would define each of 14 different acts by a parent to be 'abusive'. The acts, ranging from 'yelling' to 'burning with a cigarette', were presented under two conditions: a five-year old child who, parents claim, (1) was 'yelling and getting on my nerves', and (2) 'would not stop throwing things and damaging furniture even when told to stop over and over'. Attribution of abuse was not greatly influenced by the two given conditions which provoked it. Nurses in the U.K. were slightly more likely than U.S. nurses to consider each act abusive, but the differences were significant for only one item: beating a child with a strap. Differences were reduced controlling for race. Among the U.S. nurses, whites were more likely to see each act as abusive than blacks, but differences were significant for only two items: beating a child with a strap and confinement to a room for the day. Cultural, subcultural, and professional variations in attribution of child abuse are discussed with implications for epidemiological findings. Suggestions for directions in future research on the attribution of abuse are offered.

Black or African American↗

PubMed1984

The impact of a change in commitment procedures on the character of involuntary psychiatric patients.

The statutory requirements for involuntary civil psychiatric confinement have become increasingly restrictive. In the jurisdiction under investigation, patients were originally admitted under an Order to Apprehend (OTA) procedure simply on the petition of two affiants who indicated the patient was in need of care. A newly elected judge instituted changes requiring affiants to claim the subject was "dangerous" to self or others and asking for a clinical assessment and recommendation before signing the petitioned request for involuntary confinement. It might be expected that the more restrictive procedures would have produced a population of more assaultive patients. A study of petitions signed under in the earlier (N = 133) and later, more restrictive (N = 218) procedures indicated that the proportion of assaultive or dangerous patients was virtually identical. Further investigation, using hospital data an OTA patients from this area in both time periods, suggested that while patients were not more assaultive, they appeared to be more seriously ill or psychiatrically impaired. Apparently, movement to a dangerousness standard that allows clinical discretion in interpreting its presence may result in involuntary commitments for more seriously ill, although not necessarily more assaultive, patients.

Adolescent↗

PubMed1980

Inverted papilloma of the nasal septum.

Inverted papillomas are primarily lesions of the lateral nasal wall, but similar papillomas have been observed on the nasal septum. There is controversy as to whether papillomas on the septum should be considered differently from those of the lateral nasal wall and paranasal sinuses. A review of the records of the Massachusetts Eye and Ear Infirmary, Boston, disclosed 18 cases of inverted papilloma of the nasal septum that were treated before January 1968 and January 1980. The histologic diagnosis of inverted papilloma was confirmed by pathologists who examined histologic slides from these cases; these slides had been randomly mixed with slides of nasal vestibule squamous papillomas and slides of inverted papillomas of the lateral nasal wall. Squamous papillomas of the vestibule were readily distinguished microscopically from inverted papillomas of the septum and lateral wall that were histologically similar. The clinical course of these patients suggests that inverted papillomas of the nasal septum behave like inverted papillomas elsewhere and require wide surgical excision and careful follow-up.

Adult↗

PubMed1979