Search PubMed⌕ Search

Biomedical subjects

D A Levine

Publications and source records attributed to D A Levine.

16 recordsLinked to original sources
PubMed2001

The androgen receptor and genetic susceptibility to ovarian cancer: results from a case series.

Our objectives were to test whether polymorphic variation in the (CAG)n repeat of the androgen receptor (AR) gene affects penetrance of germ-line BRCA mutations for ovarian cancer or age of diagnosis for ovarian cancer. Using a case-series study design, 179 consecutive Ashkenazi Jewish ovarian cancer patients were genotyped for AR repeat length and BRCA mutation status. There was no association between AR repeat length and presence of a BRCA mutation. However, ovarian cancer patients from both groups (with or without BRCA mutation) who carried a short AR allele were diagnosed an average of 7.2 (95% confidence interval, 2.3-12.1) years earlier than patients who did not carry a short allele (P = 0.004). These data suggest that AR allele length affects age of diagnosis of ovarian cancer, irrespective of BRCA mutation status.

Adult↗
PubMed2001

Risk of endometrial carcinoma associated with BRCA mutation.

OBJECTIVE: Inherited mutations in the BRCA1 or BRCA2 genes are associated with a greatly increased lifetime risk of breast and ovarian cancers and a modestly increased risk of several other cancer types. Several case reports of endometrial carcinoma in women with a BRCA mutation have led to speculation regarding the effect of these genes on the risk of endometrial cancer. The purpose of this study was to test the hypothesis that germline mutation of a BRCA gene is associated with an increased risk of endometrial carcinoma. METHODS: A retrospective cohort of 199 consecutive Ashkenazi Jewish patients with endometrial carcinoma was identified from a 12-year period at this institution. All were genotyped for the three BRCA founder mutations (185delAG and 5382insC in BRCA1 and 6174delT in BRCA2) that exist in this population, and the case frequency was compared to the known population frequency of these mutations. Additionally, endometrial carcinomas occurring in patients with BRCA mutations were assessed for somatic loss of the wild-type BRCA allele. RESULTS: Germline BRCA mutations were identified in 3 (1 in BRCA1 and two in BRCA2) of 199 (1.5%) patients, compared to a frequency of 2.0% in this population generally. A relative risk of endometrial carcinoma associated with BRCA mutation, as estimated by the odds ratio, was calculated as 0.75 (95% CI = 0.24--2.34; P = 0.6). Loss of the wild-type BRCA allele was observed in two of three tumors associated with a BRCA mutation. CONCLUSIONS: For individuals with a germline BRCA mutation, the lifetime risk of endometrial carcinoma is not increased.

Aged↗
PubMed2001

Scooter injuries in children.

OBJECTIVE: To describe a series of nonmotorized scooter-related injuries to children to increase public awareness and encourage prevention of such injuries. DESIGN: A descriptive study of a consecutive series of patients. SETTING: The pediatric emergency service of a municipal hospital. PARTICIPANTS: All children <18 years old who presented to the Pediatric Emergency Service (PES) with a scooter-related injury from July through September 2000. METHODS: Patients were identified by review of the PES medical records. Charts were reviewed for patient data including age, place of injury, use of protective gear, adult supervision, injury sustained, medical management, and disposition. RESULTS: There were 15 children treated in the PES for scooter-related injuries. The mean age was 7.8 years, 73% were male. Approximately 90% of injuries occurred as a result of falling off a scooter. Irregular pavement caused 3 falls and tandem riding caused 2 falls. Inability to use the foot brake caused 1 collision, and 1 child was hit by a motor vehicle while crossing the street. Injuries occurred in a park (33%), on a sidewalk (47%), in a home (13%), and on the street (7%). Adult supervision was present in half of the cases. Only 2 children were wearing helmets at the time of injury; none wore protective padding. Five children (33%) suffered head trauma; 1 lost consciousness, and 2 suffered amnesia. Three children required a head computed tomography scan, and 1 required cervical spine radiographs. All radiographs were negative. None of these 5 children were wearing helmets. Seven children (47%) sustained facial injuries, and 4 of these children required laceration repair. Seven children (47%) sustained extremity trauma, including 1 laceration and 6 fractures (1 supracondylar, 1 distal radius, 2 radius/ulnar, 1 tibia/fibula, and 1 patella). Four fractures involved the upper extremity. Four fractures were managed by closed reduction; 2 required operative repair. One child required splinting of an avulsed tooth. Three of the children (20%) were admitted. The 5 children with head trauma were observed and released. CONCLUSION: The use of nonmotorized scooters by children may result in serious injury, particularly in the young child. Although not life-threatening, these injuries require significant medical intervention and may result in permanent functional and cosmetic deformity. These injuries are potentially preventable with the proper use of protective gear and supervision. Public and parental awareness and education are essential to prevent additional injuries.

Athletic Injuries↗
PubMed2000

Need for services in a new urban teenage clinic for men.

There has been excellent research in adolescent medicine in the last few years, research that is beginning to document the effectiveness of programs that can reduce high-risk behaviors. Adolescent clinics that feature medical care, condom availability, and clinic-based health education may change knowledge but do not change behavior. Linked programs that feature curriculum-based health education, conflict resolution, mentoring, and vocational and jobs programs may change knowledge and reduce risky behavior. There is little knowledge of what the pre-participation opinion of the teenagers is about such services. In this descriptive study of the first 46 entrants into a new teen clinic for males, clients were surveyed about which programs were desirable. Most of the clients felt medical care and free condoms were important. Many felt job-related services were desired. One half felt a general support group and health education related to sexually transmissible infections was desirable. Education about the types of services that are potentially effective may need to be provided to adolescent males to empower them to choose appropriate services.

Adolescent↗
PubMed1999

Laparoscopic management of adnexal masses in premenopausal and postmenopausal women.

OBJECTIVE: To evaluate the feasibility and safety of laparoscopic adnexal mass removal in patients without preselection for benign pathology and assess the operative complications and findings. METHODS: All patients presenting to the gynecologic oncology service between April 1992 and April 1996 with adnexal masses were candidates for laparoscopic management. Patients underwent preoperative radiological studies and office pelvic examination. Laparoscopic management was attempted on patients without evidence of gross metastatic disease or masses that extended above the umbilicus. Laparotomy was performed if indicated by pathologic findings or technical difficulty. All removed adnexal masses were sent for immediate pathologic diagnosis. The type of procedure, intraoperative findings, and complications were all recorded at the time of procedure. RESULTS: One hundred sixty patients underwent laparoscopic evaluation for an adnexal mass. Benign pathology was discovered in 139 (87%, 95% confidence interval [CI] 84, 90) patients, and 141 (88%, 95% CI 86, 91) patients were managed laparoscopically. Reasons for laparotomy included technical difficulty, operative complications, or malignancy. Frozen section diagnosis was concordant with the final pathology reports in all but five patients (97% concordance), and no discrepancies resulted in treatment delays. CONCLUSION: Laparoscopic management of adnexal masses can be successful in a gynecologic oncology population if there is expertise in operative laparoscopy, availability of immediate accurate pathologic examination, and appropriate further treatment where indicated.

Adnexal Diseases↗
PubMed1995

Personal emergency response systems: factors associated with use among older persons.

A descriptive survey was conducted to determine factors associated with the use of personal emergency response systems among older community-residing subscribers in the New York City metropolitan area. Subscribers who wore the portable help button when alone in the home were defined as being "compliant." The average length of time the 106 respondents (average age 83 +/- 9) had the system in their possession was 26 +/- 18 months. Less than 50% of the subscribers were found to be fully compliant. Compliance was more common in system users who had obtained the system themselves, had a history of falls, got positive responses to activations, used an assistive mobility device, and received instruction on the system. Compliance was less common in users who had obtained the system at the request of a family member. The data suggest that disuse is a common problem that clinicians should assess regularly to assure the benefit of this intervention.

Aged↗
PubMed1983

Visual anomia: a unidirectional disconnection.

A right-handed patient with a complete right homonymous hemianopia could not name objects seen in her left hemifield but could always select an object from an assortment when the object was named. If the right hemisphere was devoid of auditory language function, we must postulate separate transcallosal pathways from visual to verbal and from auditory language to visual information. Because only the former pathway was interrupted, our patient exhibited a "unidirectional" disconnection.

Anomia↗
PubMed1983

Symptomatic hemifacial spasm: case report and review of literature.

The purpose of this article is to discuss a case of hemifacial spasm due to a fusiform basilar aneurysm. The hemifacial spasm was successfully treated by decompression of the facial nerve in the facial canal 14 months before death due to aneurysmal rupture. The literature on symptomatic hemifacial spasm is reviewed, the pathophysiology discussed and the therapeutic options presented. Since the pathophysiology is poorly understood, conservatism is recommended.

Basilar Artery↗