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Biomedical subjects

J Levitt

Publications and source records attributed to J Levitt.

At least 19 recordsLinked to original sources
PubMed1992

Anterior cricoid split for subglottic stenosis: experience at the Children's Hospital of New Jersey.

Twenty-five children with acquired and congenital subglottic stenosis (SGS) were managed with the anterior cricoid split (ACS) operation at the authors' institution from September 1987 to January 1990. Ages ranged from 2.5 months to 5.5 years. Twenty-one (84%) of the children were extubated after 5 to 14 days of nasotracheal intubation and have remained stable after an average follow-up of 10 months. Atelectasis was a common postoperative problem, encountered in 12 (48%) of the patients. Other complications included a tracheocutaneous fistula, prolapse of soft tissue into the tracheal lumen via the cricoid incision, a subglottic granuloma, and 2 cases of prolonged lower extremity paresis following reversal of vecuronium. The results of this retrospective study indicate that the ACS is a valuable first-line procedure for the management of SGS in a variety of pediatric patients.

Child, Preschool↗
PubMed1990

Home monitors for infants: use, misuse, and "over-the-counter" use.

The prevalence of "over-the-counter" monitors, was surveyed in infants referred to five Belgian paediatric centres between September 1987 and March 1988 for evaluation of their risk for sudden infant death (SID). Questionnaires were collected from 1625 families. Of the infants, 8.9% were already being monitored at home. For 78.1% of the infants no medical advice had been solicited, and for 21.9%, a paediatrician or a general practitioner had advised home monitoring without previous evaluation. Forty of 824 infants referred with no history of SID, and no history of apparent life-threatening event (ALTE), were monitored (4.8%). Monitoring was started for 3.8% (5 out of 130) of the infants who had lost a cousin or an uncle to SID, and for 22.2% (69 of 310) of the younger siblings of a SID victim. Of the 341 infants who had presented with an ALTE, monitoring was started in 32 (9.4%). The infants were monitored with respiratory monitors only, and in 86% of the monitors, the alarm delay had been regulated unnecessarily low.

Belgium↗
PubMed1990

'JEB'--a carboplatin based regimen for malignant germ cell tumours in children.

Between February 1986 and July 1988 a total of 21 children aged 1 to 16 years with malignant germ cell tumours (MGCT), 18 with either metastatic disease or unresectable primary tumour, received the JEB regimen - carboplatin dosage calculated from the EDTA glomerular filtration rate (approximately 600 mg m-2), etoposide 120 mg m-2 daily x 3, and bleomycin 15 mg m-2 weekly. Primary sites were: testis (6), ovary (8), sacrococcyx (4), pineal gland (2) and vagina (1). AFP levels were elevated in 19, beta-HCG in 8. Complete marker response was achieved in 19 out of 19 evaluable patients and complete remission of measurable tumour in 16 out of 19, 12 with chemotherapy alone and 4 with the addition of surgery. A reduction in glomerular filtration rate greater than 10% occurred in 3 of 12 evaluable patients; in none greater than 20%. Sequential audiography was normal in 11 out of 12 evaluated. The regimen was myelosuppressive with WHO grade III or IV myelosuppression occurring in 12 patients. Three patients have relapsed; one with a pineal germinoma who relapsed in the abdomen six months after diagnosis, and two with sacrococcygeal teratomas and lung metastases. Two of these remain in second complete remission after further treatment. There was one death from probable bleomycin pulmonary toxicity. We conclude that this regimen is simple to administer and, apart from myelosuppression, it is well tolerated. It appears to have comparable efficacy to cisplatin-based regimens but with much less nephrotoxicity and ototoxicity and avoids the use of alkylating agents and anthracyclines.

Adolescent↗
PubMed1989

Long-term development of children monitored as infants for an apparent life-threatening event during sleep: a 10-year follow-up study.

The outcomes of 26 children who had an apparent life-threatening event during sleep and who were monitored at home were evaluated. In a preliminary study that was first reported when the children had a mean age of 2.7 years, only minor behavioral difficulties were seen. The children of this earlier study were characterized by more aggressive behavior, which was tentatively related to parental anxiety. The same children were retested at a mean age of 7 years (range 6 to 10 years), together with sex-, age-, and social class-matched control children. No significant differences were found in their clinical daytime and nighttime behavior or in IQ tests, although in some of the psychodevelopmental tests minor signs of anxiety were revealed. In conclusion, infants with an apparent life-threatening event who underwent continued cardiopulmonary home monitoring develop normally during preadolescence. A prolonged follow-up of the children during adolescence is needed to evaluate later school performance.

Anxiety↗
PubMed1988

Sleep characteristics in milk-intolerant infants.

We have shown that there is a relation between allergy to cow's milk and chronic sleeplessness in infants. In the present report we describe the sleep characteristics of children with allergy-related sleep disruption. We compared the polygraphic characteristics of nine infants studied before and after the exclusion of milk from the diet. The infants had a mean age of 18.3 +/- 13.3 and 25.4 +/- 12.7 weeks at the first and the second recording, respectively. Diagnosis of allergy was based on clinical observation. Sleep normalized after milk was withdrawn, deteriorated after a challenge with milk, and normalized again on a second trial of milk elimination. Before the change in diet, the infants' polygraphic recording showed frequent arousals (8-22), short sleep cycles, and a large amount of NREM1 sleep. Gastroesophageal reflux and sleep apnea were not responsible for the sleep fragmentation. After milk was excluded from the diet for 7 weeks, the infants showed striking changes in sleep quality. There was a significant decrease in number of arousals (-41.7%) and an increase in total sleep time (+22.7%) and in NREM2 and 3 sleep (+387.9%). NREM1 sleep decreased significantly (-42.1%). During the second recordings, these sleep values could not be distinguished from those of 40 age-matched controls studied in the same laboratory environments. We do not know if the observed modifications in sleep could reflect immunologic changes within the central nervous system.

Arousal↗
PubMed1988

Polysomnographic studies of infants who subsequently died of sudden infant death syndrome.

The polygraphic findings from 11 future victims of sudden infant death syndrome (SIDS) are reported and compared with those of matched pairs of control infants. The recordings had been done to alleviate parental anxiety about sleep apnea. Four infants had siblings who were victims of SIDS. Two infants were studied 3.5 to 9.5 weeks before their deaths because of an unexplained apparent life-threatening event that had occurred during sleep. For each victim of SIDS, two control infants were selected from the 2,000 infants who had been tested in the same hospitals. They were matched for sex, gestational age, postnatal age, and weight at birth with the SIDS victims. Their polygraphic recordings had been performed within similar conditions. Each record was allocated a random code number and was analyzed without knowledge of the patient's identity by two independent scorers. Most sleep and cardiorespiratory variables studied did not differentiate SIDS victims from control infants. Only four variables significantly characterized the future SIDS victims: the maximal duration of central apneas, the number of sighs followed by a central apnea, the presence of obstructive apneas, and the presence of mixed apneas. Central apneas were longer during all sleep states in the SIDS victims compared with their matched controls, but none exceeded 14 seconds. Sighs immediately followed by an apnea were significantly less frequent in the future SIDS group. Obstructive and mixed sleep apneas were seen in eight of 11 SIDS victims and in only three of 22 control infants.(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗
PubMed1986

Methylphenidate and exercise: additive effects on motor performance, variable effects on the neuroendocrine response.

It has been suggested that the effects of intensive environmental stressors and of psychostimulant drugs may be interchangeable. A specific test of this hypothesis was undertaken in a double-blind, placebo controlled, cross-over study of the stimulant drug, methylphenidate (MPH), and of intense exercise, alone and in combination. On measures of motor performance the effects of MPH and of exercise were additive while on measures of neuroendocrine response the individual and interactive effects were variable. The effects of MPH and of intense exercise are probably mediated by mechanisms that overlap to a degree but are by no means identical.

Adolescent↗
PubMed1986

Comparison of surgical and anesthetic complications in neurosurgical patients experiencing venous air embolism in the sitting position.

Because venous air embolism (VAE) has been considered to be a major deterrent to use of the sitting position, records of 255 patients undergoing neurosurgery in the sitting position from 1975 to 1982 were reviewed to determine the nature of morbidity and mortality in relation to the surgical procedure as well as to the occurrence of VAE. Complications were classified as surgical or anesthetic during joint review by a neurosurgeon and two neuroanesthesiologists. Outcome was classified on the basis of postoperative hospital course and discharge examination. The incidence of VAE was 30%. Although there was a variety of perioperative complications in patients with and without VAE, most of the complications were related to the operative procedure, not the sitting position or VAE. The episodes of VAE did not seem to be significant factors in the perioperative morbidity and mortality in our series of patients operated upon in the sitting position. Two case reports are discussed in detail.

Aged↗
PubMed1985

Effect of fibronectin on adherence of neutrophils from newborn infants.

Neutrophils (polymorphonuclear leukocytes [PMNs]) from infants and adults increased in adherence over a 20-min incubation as measured in a morphological assay. At each time point, PMNs from healthy infants had significantly diminished adherence when compared with those of adults; PMNs from sick newborn infants showed intermediate adherence values. Moreover, PMNs from healthy infants had significantly diminished membrane fluorescence for fibronectin when compared with those of adults. Preincubation with exogenous fibronectin did not augment the adherence of PMNs from infants or adults. Deficient adherence of PMNs from newborns may be related to decreased membrane fibronectin.

Adult↗
PubMed1984

The growth of technology and corporate profit-making in the clinical laboratories.

This article examines private industry's involvement in the area of clinical laboratory testing, as an example of the relationship between the increased cost of medical care and increased involvement of private industry in the health care sector. After tracing the history of corporate and technological development in the clinical laboratory field, and particularly in the area of blood chemistry analysis, the article suggests some implications for public policy of the current state of affairs.

Autoanalysis↗
PubMed1980

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