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Biomedical subjects

H Levine

Publications and source records attributed to H Levine.

At least 163 records · Page 9Linked to original sources
PubMed1984

Vascular studies in the preoperative evaluation of pituitary adenomas before transsphenoidal surgery.

The transsphenoidal approach is being increasingly utilized in the surgical treatment of pituitary microadenoma. Even with high-resolution and dynamic computed tomography (CT) scanning, subtle vascular anatomic variants and other vascular anomalies involving the parasellar carotid arteries cannot always be clearly defined. Five cases are described in which evaluation by digital intravenous subtraction angiography or standard carotid arteriography provided useful preoperative information before transsphenoidal surgery. The implications of these findings are discussed.

Adenoma↗
PubMed1983

Rehabilitation of facial paralysis in children.

We report the experience and philosophy of the Department of Otolaryngology and Communicative Disorders at the Cleveland Clinic in rehabilitation of facial paralysis in children 12 years old and younger. The causes and evaluation of facial paralysis in children and the options available for rehabilitation are considered, and the criteria, expectations, and limitations of successful rehabilitation are outlined. Depending on the limitations imposed by the clinical situation, the aims of treatment are as follows: (1) normal resting tonus, (2) symmetry at rest, (3) symmetry in motion, (4) no synkinesis, (5) appropriate mimetic function, (6) no significant loss of adjacent function, and (7) rapid return of function. Every attempt must be made to avoid causing any significant muscular or neurologic deficit and to avoid interfering with return of function of the seventh nerve, when that possibility exists.

Child↗
PubMed1983

Cutaneous carcinoma of the head and neck: management of massive and previously uncontrolled lesions.

Cutaneous basal cell and squamous cell carcinoma is the most common of malignant neoplasms. The etiology and natural history of these cutaneous neoplasms are related to actinic exposure, age, sex, hereditary factors, previous tissue injury, and chemical ingestion and exposure. Identification of cutaneous basal cell and squamous cell carcinoma is important. There are several different histologic subtypes of basal cell carcinoma, and each behaves clinically in a different way. There are several accepted methods of treatment including cryosurgery, electrodesiccation and curettage, radiotherapy, surgical excision and Mohs' histographic surgery. Each of these methods is reviewed. The vast majority of cutaneous basal cell and squamous cell carcinomas are easily cured no matter what the treatment modality. However, about 10% of these tumors (30,000 new cases each year) are not cured. These tumors often become massive and uncontrollable. Sixty patients met the criteria of being massive and/or uncontrollable. These criteria are 1. size 3 cms or greater, 2. involvement deeper than skin and subcutaneous fat, 3. four or more previous treatments without control, or 4. proven metastatic disease. These patients with massive and/or uncontrollable tumors underwent treatment with either Mohs' histographic surgery followed by conventional surgery with total microscopic marginal control or conventional excision with total microscopic marginal control. Of the 60 patients treated in this way, 53 are free of disease; 41 of these patients have been free of disease for more than 24 months. Massive and/or previously uncontrollable tumors appear to be better controlled with total microscopic marginal control while preserving as much normal tissue as possible. This technique appears to allow preservation of important esthetic and functional tissue while excising the complete tumor with the greatest degree of certainty.

Adult↗
PubMed1982

The transverse cervical trapezius myocutaneous island flap.

The transverse cervical trapezius myocutaneous island flap has demonstrated superior versatility and reliability when used in a series of eight patients. The technique differs from the previously described lateral trapezius myocutaneous flap in that the skin is centered more posterosuperior in the neck and is completely undersurfaced by a larger paddle of trapezius muscle. Experience has shown that surgical defects of the oral cavity, oropharynx, hypopharynx, and skin of the cheek may be repaired with this flap with an acceptable incidence of complications. The advantages and disadvantages of this flap compared with other popular myocutaneous flaps are discussed.

Cheek↗
PubMed1982

Carbon dioxide laser treatment of cutaneous hemangiomas and tattoos.

Many modalities have been advocated for the removal of cutaneous hemangiomas and tattoos, including dermabrasion, salabrasion, and surgical excision. These methods often result in incomplete removal, unsatisfactory wound healing, and excessive postoperative pain. In hopes of avoiding these problems and improving the results, the carbon dioxide laser has been used on 16 patients with 22 tattoos of the skin and 25 patients with cutaneous hemangiomas. This article describes the surgical techniques used for the carbon dioxide laser removal of these lesions and the postoperative care involved. The existing literature on the use of the carbon dioxide and argon laser for cutaneous lesions is reviewed.

Carbon Dioxide↗
PubMed1982

Antigen recognition by human T lymphocytes is linked to surface expression of the T3 molecular complex.

Four distinct surface molecules on human T cells are defined by the monoclonal antibodies anti-T1, anti-T3 (anti-T3A), anti-T11 and anti-T12. Following cell binding, anti-T3 (anti-T3A) and anti-T1 induce independent modulation of their respective ligands, whereas anti-T11 and anti-T12 do not. To explore the biological consequences of this modulation, we used cloned populations of T4 and T8 cytotoxic T lymphocytes. Anti-T3 (anti-T3A), but not anti-T1, inhibits cytotoxic T lymphocyte effector function by T4 and T8 clones as well as antigen-specific T cell recognition. The latter is not secondary to a generalized inhibitory effect since responsiveness to interleukin 2 is maintained. Moreover, after modulation, cytotoxic T lymphocytes recover cytolytic function in parallel with reexpression of surface T3 molecules. We provide evidence for a direct linkage between antigen recognition by T lymphocytes and surface expression of the T3 molecular complex.

Antibodies, Monoclonal↗
PubMed1982

Reconstitution after transplantation with T-lymphocyte-depleted HLA haplotype-mismatched bone marrow for severe combined immunodeficiency.

Severe combined immunodeficiency (SCID) is potentially correctable by bone marrow transplantation if a patient has a suitable histocompatible donor. In the absence of an HLA-matched donor, lethal graft-versus-host disease (GVHD), which is mediated by alloreactive donor T cells, may occur. In an attempt to prevent GVHD in one SCID patient lacking a matched donor, we treated maternal haplomismatched bone marrow with a unique nonmitogenic T-cell-specific monoclonal antibody (anti-T12) and complement to remove mature T cells. Despite the removal of greater than 99% mature T cells, the child developed significant life-threatening GVHD, which was terminated by a 5-day course of intravenous anti-T12. Subsequently, immune reconstitution occurred by 6 wk: the mature circulating T cells proliferated in response to soluble and allo-antigens in vitro and provided help for B-cell immunoglobulin synthesis. The patient was removed from a protective environment and discharged without evidence of further infection. Both HLA and chromosomal analyses showed that the circulating cells in the patient were of maternal origin. More importantly, the maternal T cells were no longer reactive with recipient cells. Mixing experiments indicated that the state of tolerance that resulted in this chimera was not due to active suppression. We conclude that HLA-mismatched transplantation for SCID can be undertaken if mature alloreactive donor T lymphocytes are depleted before and after bone marrow grafting.

Antibodies, Monoclonal↗
PubMed1982

An approach to total maxillectomy with emphasis on orbital preservation.

In view of recent reports suggesting that the orbital contents may be preserved in total maxillectomy for maxillary sinus carcinoma in cases where gross tumor is not found to invade the orbital periosteum, a technique has been presented that emphasizes the preservation of the orbital contents with the restoration of function. The main differences between this technique and the classical one are (1) a modified incision designed to reduce lower lid complications, (2) the preservation of the malar eminence, (3) the preservation of the premaxilla and teeth, and (4) the use of lyophilized dura as a sling for the remaining orbital contents.

Humans↗
PubMed1982

Changes in indications for heart transplantation. An additional argument for the preservation of the recipient's own heart.

The 1 year survival rate after heart transplantation since 1967 from +/-30% to +/-70%, and the 5 year survival rate is now +/-50%. This improvement has brought renewed interest in this procedure, now done in about twenty centers in eight countries, and increased confidence has widened the indication to patients who are less than terminally ill, to restore quality of life. This trend is illustrated by the Cape Town series, which can be divided into two parts: 10 patients treated by orthotopic heart transplantation (OHT), from 1967 to 1973, and 40 patients treated by heterotopic heart transplantation (HHT), from 1974 to 1981. The HHT group was younger (mean 37 +/- 10 years versus 51 +/- 9 years, p less than 0.001), had been ill for a shorter length of time (mean 3.6 +/- 0.7 years versus 6.6 +/- 1.4 years, p less than 0.091), and were in a lower New York Heart Association (NYHA) class (mean 3.45 +/- 0.11 versus 3.9 +/- 1.0, p less than 0.006). The improved survival is linked to patient selection, progress in management, and switch to HHT, but not to progress in matching between donor and recipient. Since there is no means to predict tolerance of the donor heart, HHT limits the risks from unforseeable mismatch. The recipient's heart is a built-in assist device, maintaining life when the donor heart fails acutely at operation or during acute [three cases] or chronic [two cases] rejection. Had these patients undergone OHT they would have died. Comparing the 10 oldest HHT patients with the OHT series, no difference in pretransplant parameters was found. However, survival of HHT recipients was longer during the critical post-HHT period: at 3 months, p less than 0.011; at 6 months, p less than 0.05. Larger series will separate the effects of progress in management from the intrinsic advantages of HHT. Retaining the recipient's heart is logical and has brought few complications. Survival rate of 40 HHT patients was 73% at 6, 65% at 12, and 51% at 36 months; 85% of survivors are in NYHA Class I. In patients in less than desperate condition, but who refuse to remain cripples, HHT eliminates the growing ethical problem of removing a recipient's heart that may still support the patient.

Adolescent↗
PubMed1982

T cell and IR gene regulation of expression of a cross-reactive idiotype.

The immune response to the chemically defined DNP-oligo-L-lysine antigens is under Ir gene control in the guinea pig. Strain 2 (responder) guinea pigs mount a highly specific T cell-mediated and humoral immune response capable of discriminating closely related DNP-peptides. In contrast, strain 13 (nonresponder) animals fail to mount a cell-mediated response, and produce antibody that is only DNP-specific. In these studies a common idiotypic determinant is defined on highly specific anti-epsilon,DNP-Lys10 antibody produced by strain 2 guinea pigs. Ir gene nonresponder antibody is idiotype-negative. The presence of the idiotypic determinant distinguishes responder anti-epsilon,DNP-Lys10 antibody from responder antibodies elicited by structurally related antigens such as epsilon,DNP-Lys9 and alpha,DNP-Lys10-. Investigation of the regulation of idiotype expression demonstrated that production of idiotype-positive antibody requires the presence of viable, antigen-responsive T cells. Moreover, genetic analysis revealed that expression of the shared idiotype correlates directly with the phenotypic expression of I region genes (DTH responsiveness, Ia antigens) in (2 x 13)F1 x 13 backcross and randomly bred Hartley guinea pigs. Thus, Ir gene regulation of the immune response may be reflected in the v region specificities expressed by antigen-specific B cell clones.

Animals↗
PubMed1982

Repeated isolation of unique Qa2+ Ia+ clonally derived cell lines from Qa2- mice.

Qa2+ tumor cell lines were previously isolated from individual BALB/cBy (Qa2-) splenic lymphomas induced by murine sarcoma virus-murine leukemia virus-Moloney (MSV-MuLV-M). Two clonally derived cell lines, ORA I-a and Thorbly, and one noncloned cell line, BOMS, expressed Qa2, but neither Ly-1 nor Ly-2 were detected. In order to determine whether eight cloned and two noncloned tumor cell lines all represented a unique population of transformed cells, the presence of a series of surface differentiation antigens as studied. In addition to Qa2, each cell line examined expressed IAd, IEd, H-2Kd, H-2Dd, and receptors for C3b and the Fc portion of immunoglobulin (Ig). Neither Thy-1.2 nor Ig were detected on the cell surfaces, and cytoplasmic Ig was not precipitated from metabolically radiolabeled and detergent-solubilized cell extracts. However, monocyte specific alpha-napththyl acetate esterase-containing granules were present in all cell lines examined. Therefore, a unique Qa2+ monocytic cell is repeatedly isolated after chronic MSV-MuLV-M infection. Further analysis of these cells may provide insight into both the regulation of Qa2 expression and the interactions between monocytes and lymphocytes during leukemogenesis.

Animals↗
PubMed1982

Pulmonary dysfunction in sepsis: is pulmonary edema the culprit?

Pulmonary dysfunction is a well-recognized sequela of sepsis, which has been quantitated by calculation of intrapulmonary shunt (Qs/Qt) and, more recently, by measurement of extravascular lung water (EVLW). We sought to demonstrate the relationship between Qs/Qt and EVLW in sepsis. Nine pigs were given live E. coli infusions and five control pigs received only crystalloid. Pulmonary artery pressure (PAP), pulmonary artery wedge pressure (PAWP), arterial blood gases (ABG), and mixed venous blood gas levels were measured serially and Qs/QT calculated. EVLW was measured simultaneously using the thermal-green dye technique. The septic group showed increases from baseline in PAP (2.4 X), EVLW (2x), and Qs/Qt (1.6x). Regression analysis of Qs/Qt or EVLW yielded a correlation coefficient of r = 0.48. We concluded that while sepsis can result in both increased EVLW and Qs/Qt, the correlation is not sufficiently strong to account for the increased Qs/Qt on the basis of elevated EVLW alone. The possible relationships of arterial hypoxemia and pulmonary edema, ventilation-perfusion mismatch, and alterations in the normal hypoxic vasoconstrictive response in sepsis are considered.

Animals↗
PubMed1981

Human cell lines express multiple populations of Ia-like molecules.

Three monoclonal antibodies have been used to isolate Ia-like antigens from three human cell lines; two of which are thought to be homozygous at the HLA-D/DR locus. Complete extraction of the Ia antigens identified by one antibody leaves those recognized by the two remaining antibodies in three parallel sets of experiments, indicating that the antigenic determinants recognized by these antibodies are present on three different populations of Ia molecules from cells of single individuals. These three populations of Ia-like molecules may reflect serologic variants of the product of a single genetic locus or may represent the products of as many as three nonallelic genetic regions. Demonstration of the existence of these multiple populations of Ia-like molecules on presumed homozygous typing cells indicates that this antigenic system is much more complex than has been generally realized. Further study may clarify the relationship between HLA-D/DR type and susceptibility to a variety of diseases and ultimately lead to better matches and improved survival for allogenic transplants. Since the HLA-D region is intimately involved in regulation of the immune response and susceptibility to a variety of diseases, use of monoclonal antibodies specific for discrete Ia antigens, the only identified products of the HLA-D region, may facilitate dissection of its many biological functions.

Antibodies, Monoclonal↗
PubMed1981

Familial and individualized longitudinal autorhythmometry for 5 to 12 years and human age effects.

Statistically significant and biologically interesting changes (no decrease and even an increase) with age may characterize peak expiratory flow. This variable and others were investigated in the same persons by dense measurements for several years. A possible health benefit from the monitoring of personal health thus becomes apparent. The relative prominence of changes in body core temperature and 2-min estimation with circadian rhythms, as compared to those with aging is of basic interest. The population-based presumption that aging necessarily involves an increase in overall-systolic and diastolic blood pressure is here aligned with an unusually well documented exception to this view.

Adolescent↗
PubMed1981

A controlled clinical trial of "family care" compared with "child-only care" in the comprehensive primary care of children.

We performed a randomized controlled clinical trial in a health center serving a poor population to attempt to find the differences, if any, between the effectiveness of primary care provided to children by two patterns of comprehensive medical care practiced by a pediatrician-internist-allied health team--one pattern offering care exclusively to children and the other offering care to both children and their parents. The study demonstrated few measurable differences between the two groups of children in either utilization or outcome. Where there were differences, most tended to favor slightly the family pattern of care: older children maintained their use of the center, immunization was somewhat more timely and children over time appeared to make fewer visits to sources of ambulatory care other than the health center. The absence of more or greater measurable differences may be due to the relatively short period of study, to the extremely disadvantaged population served, to the special model of family care used or to the comprehensive, team-based care provided to both groups of children.

Adult↗