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Biomedical subjects

H S Levin

Publications and source records attributed to H S Levin.

At least 73 records · Page 4Linked to original sources
PubMed1997

Isolated splenic metastases from colon cancer.

Metastatic tumors of the spleen are rare and usually occur in the presence of disseminated visceral metastases. The liver is the most common site of metastatic spread from colon cancer. We report a case of isolated intrasplenic metastasis from sigmoid colon cancer and review the possible reasons for the rarity of splenic metastasis. This represents the fifth reported case of isolated splenic metastasis from colon cancer. Splenectomy may be justified in presence of isolated metastatic disease, since it is an operation with a low complication rate and may provide potential long-term survival in colon cancer.

Adenocarcinoma↗
PubMed1997

Longitudinal neuropsychological outcome in infants and preschoolers with traumatic brain injury.

Neuropsychological outcome was evaluated in a prospective, longitudinal follow-up study of children age 4 months to 7 years at injury with either mild-to-moderate (N = 35) or severe (N = 44) traumatic brain injury (TBI). Age-appropriate tests were administered at baseline, 6 months, 12 months, and 24 months after the injury. Performance was compared on (1) Composite IQ and motor, (2) Receptive and expressive language, and (3) Verbal and Perceptual-Performance IQ scores. In comparison to mild-to-moderate TBI, severe TBI in infants and preschoolers produced deficits in all areas. Interactions between task and severity of injury were obtained. Motor scores were lower than IQ scores, particularly after severe TBI. Both receptive and expressive scores were reduced following severe TBI. Expressive language scores were lower than receptive language scores for children sustaining mild-to-moderate TBI. While severe TBI lowered both Verbal and Perceptual-Performance IQ scores, Verbal IQ scores were significantly lower than Perceptual-Performance IQ scores after mild-to-moderate TBI. Mild injuries may produce subtle linguistic changes adversely impacting estimates of Verbal IQ and expressive language. Within the limited age range evaluated within this study, age at injury was unrelated to test scores: The impact of TBI was comparable in children ages 4 to 41 months versus 42 to 72 months at the time of injury. All neuropsychological scores improved significantly from baseline to the 6-month follow-up. However, no further change in scores was observed from 6 to 24 months after the injury. The persistent deficits and lack of catch-up over time suggest a reduction in the rate of acquisition of new skills after severe TBI. Methodological issues in longitudinal studies of young children were discussed.

Age Factors↗
PubMed1997

Concept formation and problem-solving following closed head injury in children.

To further investigate the usefulness of 3 purported measures of executive function (EF) in head injured children, we administered the Twenty Questions Test (TQT), Tower of London (TOL), and the Wisconsin Card Sorting Test (WCST) to 151 children who had sustained a closed head injury (CHI) of varying severity about 3 years earlier. In addition, we tested 89 normal controls. Fifty-seven of the patients were included in a longitudinal study that compared performance at 3 months and 36 months. All of the head injured children underwent magnetic resonance imaging for investigational purposes. Severity of CHI, as defined by the lowest Glasgow Coma Scale (GCS) score, affected performance on all 3 EF measures. Focal lesion volume incremented prediction of performance on TOL and WCST, but not TQT. Moderate intercorrelations of the test variables were obtained. Although all three EF measures depicted changes in performance over 3 years, a ceiling effect detracted from the sensitivity of the TOL to the impact of CHI on development. Implications of the findings for clinical applications are discussed.

Adolescent↗
PubMed1996

Dyscalculia and dyslexia after right hemisphere injury in infancy.

OBJECTIVE: To use the findings from neuropsychological evaluation and functional magnetic resonance imaging (fMRI) to assess interhemispheric reorganization of function after early unilateral brain injury. DESIGN AND METHODS: The study focused on one case of early brain injury that resulted in both dyscalculia and dyslexia. Brain injury was studied using both structural and fMRI. Intellectual function was evaluated using the Wechsler Intelligence Scale for Children, Third Edition, while visuospatial skills were assessed using the Block Design subtest of the Wechsler Intelligence Scale for Children, Third Edition, and Judgment of Line Orientation subtest. The Selective Reminding Test and the Recurring Figures Test were used to evaluate memory and orientation; language and speech skills were evaluated using the Boston Naming Test, Controlled Oral Word Association, Gates-MacGinitie Reading Test, and color naming. Various methods were used to study arithmetic skills, including the Wide Range Achievement Test-Revised and the Peabody Individual Achievement Test. The control group for fMRI consisted of nine normal subjects. SETTING: Neuropsychological laboratory in primary care hospital. PATIENT: A 17-year-old boy who had sustained a closed head injury associated with a partially depressed, right parietal skull fracture, and right temporal hemorrhage in a motor vehicle crash at age 7 months (November 9, 1977). Subsequent social behavior was normal, but the patient had difficulty throughout school in mathematics and spelling and was characterized as having a "short attention span." INTERVENTION: None. MAIN OUTCOME MEASURES: Standardized tests of arithmetic and reading supplemented by an assessment of calculation and quantitative skills. While performing calculations, fMRI disclosed predominantly left hemisphere activation involving the frontal and posterior parietal regions, whereas this task produced bilateral activation of the supramarginal gyrus in seven of nine normal subjects. RESULTS: Neuropsychological findings confirmed the presence of dyscalculia and dyslexia despite normal intellectual functioning. Visuospatial skills ranged from the low normal to average level. The fMRI findings were consistent with early interhemispheric transfer of visuospatial skills normally committed to the right parietal area to the left parietal region. The patient's dyscalculia and reading ability raise a question of acquired left parietal dysfunction as a consequence of the competition between verbal and visuospatial functions for left hemisphere representation. CONCLUSION: Interhemispheric reorganization of function may be bidirectional rather than a feature unique to the left hemisphere substrate for language.

Adolescent↗
PubMed1996

Posttraumatic Amnesia as a predictor of outcome after severe closed head injury. Prospective assessment.

OBJECTIVES: To identify the demographic and clinical variables related to the duration of posttraumatic amnesia after severe closed head injury; to evaluate the usefulness of posttraumatic amnesia duration in predicting outcome at the time of hospital discharge and at 6 months after injury. SETTING: Four clinical centers located in primary care hospitals. PATIENTS: Three hundred fourteen severely injured subjects aged 16 years or older who did not have trauma as a result of a penetrating injury and came out of coma before hospital discharge. INTERVENTIONS: Approximately half of the subjects were administered phenytoin sodium for some period after termination of coma; 17% were administered dexamethasone and 41% morphine sulfate. MAIN OUTCOME MEASURES: Galveston Orientation and Amnesia Test scores defined the duration of posttraumatic amnesia. The Glasgow Outcome Scale was used to grade outcome at the time of hospital discharge and at 6 months. RESULTS: Older age, low initial Glasgow Coma Scale score, nonreactive pupil(s), coma duration, and use of phenytoin were associated with a longer duration of posttraumatic amnesia. Poor pupillary response, time in coma, and duration of posttraumatic amnesia and use of phenytoin was predictive of the 6-month outcome. CONCLUSIONS: The results support the prognostic usefulness of prospectively measuring duration of posttraumatic amnesia after termination of coma. Pending replication, our findings suggest that posttraumatic amnesia duration may be a useful surrogate outcome measure for clinical trials involving interventions for acute head injury.

Adult↗
PubMed1996

Subacute methylphenidate treatment for moderate to moderately severe traumatic brain injury: a preliminary double-blind placebo-controlled study.

OBJECTIVE: To determine the effect of subacute administration of methylphenidate on recovery from moderate to moderately severe closed head injury. DESIGN: Double-blind placebo-controlled with random assignment. Patients were enrolled when their Galveston Orientation and Amnesia Test score was at least 65. Drug/placebo treatment began the day following baseline cognitive assessment and continued for 30 consecutive days. Follow-up evaluations were conducted at 30 and 90 days after baseline, after discontinuation of drug/placebo. SETTING: A level I trauma center. PATIENTS: Twenty-three patients ranging in age from 16 to 64 years. Head injury severity ranged from moderately severe (Glasgow Coma Score [GCS] < or = 8, no intracranial pressure monitor) to "complicated mild" (GCS from 13 to 15 with positive computed tomography brain scan). Thirty-day follow-up was based on 12 patients, whereas 90-day evaluation was based on 9 patients, with complicated mild head injuries excluded from the analyses. INTERVENTIONS: Methylphenidate administered twice daily at a dose of .30 mg/kg; placebo administered according to the same schedule in identical pill form. MAIN OUTCOME MEASURES: The Disability Rating Scale (DRS) and tests of attention, memory, and vigilance. RESULTS: The methylphenidate group was significantly better at 30 days on the DRS (p < .02), and on tests of attention (p < .03) and motor performance (p, .05). No significant differences were noted between groups at 90 days. CONCLUSIONS: Subacute administration of methylphenidate after moderately severe head injury appeared to enhance the rate but not the ultimate level of recovery as measured by the DRS and tests of vigilance. Problems with possible selection bias and small sample size limit generalization of results.

Adolescent↗
PubMed1996

Semantic memory following pediatric head injury: relationship to age, severity of injury, and MRI.

The effects of closed head injury (CHI) severity (mild vs. severe) and age at injury were analyzed in a longitudinal study (3. 12 months postinjury) of semantic memory which used magnetic resonance imaging (MRI) to characterize focal brain lesions. Semantic memory was evaluated by word and category fluency, semantic verification, semantic clustering in word list recall, and vocabulary. Episodic memory was assessed by word list recall. Comparison of normal control (n = 104) data with the patients' data (n = 77) at 3 months postinjury disclosed semantic and episodic memory deficits in the severe CHI patients. Analysis of the longitudinal data revealed significant effects of age at injury for all of the semantic memory measures. The effects of injury severity were confined to the latency of verifying correct statements. Volume of left frontal and extrafrontal lesions was predictive of performance on several semantic memory measures, but less robust for right hemisphere lesions.

Adolescent↗
PubMed1996

Intraoperative evaluation of renal cell carcinoma: a prospective study of the role of ultrasonography and histopathological frozen sections.

PURPOSE: Nephron sparing surgery is being performed increasingly for treatment of renal cell carcinoma, including in select patients with a normal contralateral kidney. The number of tumors in the involved kidney (single versus multiple) and presence or absence of perinephric fat involvement (pathological stage T1 to 2 versus T3A) are important prognostic factors. In a prospective study we evaluated the accuracy of intraoperative histopathological frozen section analysis of renal capsular biopsies for assessing local tumor stage, and the accuracy of intraoperative ultrasonography for assessing tumor focality. MATERIALS AND METHODS: Intraoperative frozen section biopsies and ultrasonography were compared with information obtained from preoperative computerized tomography (CT), intraoperative inspection of the kidney by the surgeon and permanent histopathological specimens. RESULTS: We evaluated 99 patients (102 kidneys) with localized sold renal masses undergoing either radical nephrectomy (48) or nephron sparing surgery (54). Final pathological analysis revealed 95 renal cell carcinomas (stage T3A in 24), 6 oncocytomas and 1 angiomyolipoma. Multiple tumors were detected in 18 of 102 kidneys overall. Frozen section analysis identified 87% of the stage T3A lesions with no false-positive results, compared to CT, which only identified 67%. Ultrasonography identified 14 of 18 multifocal tumors (78%) and was not more accurate than the combination of CT and intraoperative inspection. However, during nephron sparing surgery ultrasonography was useful to localize the intrarenal extent of tumors (17 cases). CONCLUSIONS: Our results clarify the role of intraoperative ultrasonography and frozen section analysis in patients undergoing nephron sparing surgery for renal cell carcinoma. Frozen section analysis may be useful in select patients with small peripheral tumors who are under consideration for elective nephron sparing surgery.

Carcinoma, Renal Cell↗
PubMed1996

Testicular cancer in association with developmental renal anomalies and hypospadias.

OBJECTIVES: To characterize the clinical, pathologic, and genetic aspects of patients with a previously undescribed phenotype of testicular germ cell tumors associated with renal hypoplasia or agenesis and urethral hypospadias. METHODS: Review of clinical and pathologic findings and genetic analysis of constitutional and tumor DNA for mutations of the Wilms' tumor suppressor gene (WT1). RESULTS: Clinical findings suggest that this phenotype is distinct from other syndromes associated with renal anomalies and that the associated testicular tumors are histologically and clinically similar to those that occur sporadically. No karyotypic abnormalities, loss of heterozygosity, or mutations in the zinc finger domains (exons 7-10) of WT1 were observed in 5 patients with this phenotype. CONCLUSIONS: The phenotype of testicular germ cell tumor, developmental renal anomalies, and urethral hypospadias constitutes a discrete syndrome caused by a gene distinct from WT1.

Adult↗
PubMed1996

Behavioral outcomes after pediatric closed head injury: relationships with age, severity, and lesion size.

This study investigated the behavioral outcomes and adaptive functioning of 138 children with mild to severe closed head injury in the 6- to 16-year age range. Each child was evaluated with the Personality Inventory for Children-Revised. A subset of this sample (n = 77) received the Vineland Adaptive Behavior Scales. Results revealed little evidence for group differences based on severity of closed head injury on scales associated with psychopathology on the Personality Inventory for Children-Revised. However, children with severe closed head injury were viewed as experiencing more difficulties than children with mild-moderate closed head injury on those components of the Personality Inventory for Children-Revised most closely associated with cognitive functions. In addition, on the Vineland Adaptive Behavior Scales, severely injured children had lower scores on the Communication and Socialization scales than children with mild-moderate injury. Relationships between the size of frontal and extrafrontal lesions from concurrent magnetic resonance imaging and behavioral outcomes were not apparent. This study suggests that outcome measures assessing adaptive behavior and cognitive functions are more sensitive to severity of closed head injury than parent-based scales of internalizing and externalizing psychopathology.

Adolescent↗
PubMed1996

Benton Controlled Oral Word Association Test: reliability and updated norms.

The aim of this paper is to update the over 20-year-old normative data for the Benton Controlled Word Association (COWA) Test. In a sample of 360 normal volunteers, the age ranged between 16-70 years, and the educational level ranged from 7-22 years. Care was taken to ensure that the population was heterogeneous, yet the two stratifications of gender, four age, and three educational groups led to 24 cells with 15 individuals in each. Test-retest reliability was established by testing 30% of the sample after a 6-month delay, which represents a typical follow up duration between testings in a clinical setting. The two forms of the COWA revealed significant test-retest reliability. Generally, our updated values fall above the original normative values, which were derived from a less well-educated and rural sample. No major gender or age trends were noted, but the COWA test performances were influenced by education, i.e., as the level of education increased, the performance on the COWA increased. The only gender differences that were found were for the women in the highest educational group ( > 16 years), who performed significantly better that men in the highest educational group. An error analysis of repetitions or perseverations is provided, with cut-off scores according to age levels. Finally, the updated COWA norms are compared to the original norms as well as to other measures of word fluency.

Journal Article↗
PubMed1996

Adenomatoid tumor of the adrenal gland: a report of four new cases and a review of the literature.

Adenomatoid tumors of the adrenal gland are rare, benign, asymptomatic neoplasms that are usually found incidentally. Previously reported cases occurred only in men and only on the left side. We report four cases, including two from the right adrenal gland, one from a woman, and one with a cystic component. The average age of our patients was 49 years, compared with the average age of 34 years in previously reported cases. Our immunohistochemical stains and electron microscopic analysis support the presumed mesothelial derivation of these tumors. The differential diagnosis of adenomatoid tumors of the adrenal gland includes a variety of solid and cystic tumors. It is important to recognize these rare tumors to avoid misclassifying them, especially as metastatic or primary malignant vascular tumors.

Adenomatoid Tumor↗
PubMed1995

Open pelvic lymph node dissection for prostate cancer: a reassessment.

OBJECTIVES: To provide a risk-to-benefit analysis of open staging pelvic lymph node dissection (PLND) for prostate cancer. METHODS: The medical records of all patients presenting with prostate cancer from July 1989 to April 1994 were reviewed. A total of 245 patients with clinically localized disease were selected to undergo radical retropubic prostatectomy (RRP) preceded by open PLND. Univariate and multivariate analyses were performed to evaluate the predictive value of the preoperative serum prostate-specific antigen (PSA) concentration, clinical stage, and Gleason score with regard to final nodal status. The cost and morbidity associated with PLND in the setting of RRP was also defined. RESULTS: Overall, only 16 patients (6.5%) had lymph node metastases. Lymph node involvement correlated significantly with elevated serum PSA values (P = 0.0001), high Gleason score (P = 0.0022), and advanced clinical stage (P = 0.0001). Lymph node metastases were particularly uncommon in patients with nonpalpable tumors (1 of 67 [1.5%]), PSA values less than 10 (2 of 154 [1.3%]), and Gleason score less than 6 (1 of 26 [3.8%]). Overall, 179 patients (73.1%) presented with at least one or more of these favorable characteristics, and only 4 (2.2%) had lymph node involvement. Complications related to the lymphadenectomy occurred in 10 patients (4.1%). The cost per metastasis diagnosed in patients with low-risk characteristics was approximatley $43,600. CONCLUSIONS: An open staging PLND may no longer be justified on a routine basis in patients undergoing radical retropubic prostatectomy.

Adenocarcinoma↗
PubMed1995

Neurobehavioral outcome of closed head injury: implications for clinical trials.

This review encompasses the neurobehavioral sequelae of moderate to severe closed head injury (CHI). Following a discussion of posttraumatic amnesia and its measurement, the paper discusses assessment of the global outcome of CHI using the Glasgow Outcome Scale. Domains of residual neurobehavioral sequelae that are reviewed include attention/information processing speed, memory, language, intellectual ability, executive functions, and motor speed. The contribution of behavioral disturbance and psychosocial maladjustment to overall outcome is reviewed, as is the impact on the family. Finally, the neurobehavioral outcome measures for clinical trials involving moderate to severe head-injured patients are presented. Caveats for completing clinical trials that involve assessment of neurobehavioral functioning are provided.

Adult↗
PubMed1995

Prediction of recovery from traumatic brain injury.

This paper encompasses the prediction of early and late recovery from traumatic brain injury (TBI). Predictors of the duration of coma and the utilization of posttraumatic amnesia duration to predict residual memory function are discussed. The issues surrounding prediction of long-term neurobehavioral recovery from TBI are considered, particularly the patient and clinical variables that are related to intellectual recovery. Findings from the NIH Traumatic Coma Data are reviewed pertaining to testability as a criterion for outcome. In addition to discussing the relationship of specific neurologic indices of TBI as predictors, the results obtained using a regression model are summarized. Finally, the relationship of neuroimaging findings to neurobehavioral outcome is discussed including directions for future research.

Brain Injuries↗
PubMed1995

Frontal lobe changes after severe diffuse closed head injury in children: a volumetric study of magnetic resonance imaging.

In view of the pathophysiology and biomechanics of severe closed head injury (CHI) in children, we postulated that the frontal lobes sustain diffuse injury, even in the absence of focal brain lesions detected by magnetic resonance imaging (MRI). This study quantitated the morphological effects of CHI on the frontal lobes in children who sustained head trauma of varying severity. The MRI findings of 14 children who had sustained severe CHIs (Glasgow Coma Scale score of < or = 8) were compared with the findings in a matched group of 14 children having sustained mild head injuries (Glasgow Coma Scale score of 13-15). The patients ranged in age from 5 to 15 years at the time of their MRIs, which were acquired at least 3 months postinjury. MRI findings revealed no focal areas of abnormal signal in the frontal lobes. Volumetric analysis disclosed that the total prefrontal cerebrospinal fluid increased and the gray matter volume decreased in the patients with severe CHI, relative to the mildly injured comparison group. Gray matter volume was also reduced in the orbitofrontal and dorsolateral regions of the brains of children with severe CHI, relative to the children who sustained mild head trauma. These volumetric findings indicate that prefrontal tissue loss occurs after severe CHI in children, even in the absence of focal brain lesions in this area. Nearly two-thirds of the children who sustained severe CHIs were moderately disabled after an average postinjury interval of 3 years or more, whereas 12 of the 14 patients with mild CHIs attained a good recovery (2 were moderately disabled) by the time of study.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

Sleep apnea and vigilance performance in a community-dwelling older sample.

Impaired vigilance performance has been reported in older subjects with sleep apnea syndrome (SAS). The current study is an attempt to extend these findings and to investigate additional factors that might have implications for vigilance in the older adult. Fifty-nine older adults [age: 62 +/- 5 (mean +/- SD), range 54-75 years; respiratory disturbance index (RDI): 8.8 +/- 14.4 (mean +/- SD), range 0-67.5] were categorized as SAS or NotSAS, based on various classification criteria [i.e. apnea index (AI) > or = 5, and 10, RDI > or = 5, 10 and 15], and were compared on their vigilance performance as assessed by the computer program "Steer Clear". Vigilance performance did not discriminate the groups, independent of how they were formed. Groups were then formed based on vigilance performance (HiVig vs. LowVig) and compared on assorted sleep variables, periodic leg movements, and self-reported hypersomnolence and depression. Only age discriminated vigilance performance (an inverse relationship), accounting for 31% of the observed variance. Our findings suggest that subject selection may unintentionally bias findings regarding the neuropsychological functioning of individuals with SAS, that vigilance may be impaired only in relatively more "severe" SAS, and that severity of SAS in older adults may not be well characterized by current classification standards. Age clearly impacted vigilance performance, despite the constricted age range sampled, and should be taken into account in future research.

Age Factors↗