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Biomedical subjects

L Levi

Publications and source records attributed to L Levi.

At least 55 records · Page 3Linked to original sources
PubMed1991

Neuroendocrine and immunologic effects of unemployment and job insecurity.

We prospectively followed a cohort of 354 blue-collar men and women, some of whom lost their jobs. Results show marked effects during the anticipatory and early unemployment phase on mental well-being, serum cortisol, prolactin, total cholesterol, HDL cholesterol, and phytohemagglutinin reactivity of lymphocytes. Most of these changes appear to be of short-term duration. However, changes in cardiovascular risk factors are observed at least 2 years following the loss of one's job. Coping style appears to be a major determinant whether or not and how people will react to unemployment.

Adaptation, Psychological↗
PubMed1991

The association between skull fracture, intracranial pathology and outcome in pediatric head injury.

We prospectively studied 653 consecutive head-injured children (less than or equal to 14 years old) treated over a 54-month period (1984-88) at the Department of Neurosurgery of the Rambam Medical Center (Haifa, Israel). Demographic and clinical data were collected, the patients were divided into five age groups (birth to 2 years, 169; 3-5 years, 194; 6-9 years, 164; 10-12 years, 77; and 13-14 years, 49), and the information relative to each was then compared. All patients (except three who died on the operating table) underwent computed tomography (CT) scans; 225 (34.6%) had intracranial pathology, e.g. focal mass lesions, diffuse axonal injury, and subarachnoid haemorrhage. The rate of detected pathology increased with age. Skull fracture was documented in 468 (72%) patients. Craniotomies were done on 114 (17.5%) patients. After 3 months, the patients were classified as having good recovery (84.8%), moderate disability (5.5%), or severe disability (2.3%); 0.9% were in a vegetative state. The mortality was 6.6% (43 patients); of these, 39 (90.7%) had admission Glasgow Coma Scale scores below 8. In our area the annual incidence of neurosurgical hospitalization due to head injury in the pediatric group was 37.6 per 100,000 inhabitants per year. This study substantiates the findings of other series on the effects of prognosis of factors such as associated trauma, admission Glasgow Coma Score, mass lesions with persistent intracranial pressure elevation, or diffuse axonal injury.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

Penetrating craniocerebral injuries in civilians.

During a 6-year period (1984-89), 31 patients were treated at Rambam Medical Center with penetrating craniocerebral injuries (PCCI) not associated with military action. Eighteen (58%) patients died during their initial hospitalization; only two of them had admission Glasgow Coma Scale (GCS) above five. The admission GCS coupled with the mode of injury (type of missile and motivation of shooting) were valuable for early accurate prognosis assessment. Patients with admission GCS of 3 and 4 invariably died despite rapid treatment and attempted haematoma evacuation. The neurological status, CT appearance, as well as the motivation of shooting should be considered in order to assess accurately the possible outcome. Compared with our military series of 113 patients with PCCI, there were more extensive injuries, although the mean period until neurosurgical treatment was the same. Long-term complications connected to dural tears remote from the entrance wound occurred in three of the survivors.

Adolescent↗
PubMed1991

Operative management of bilateral facet dislocation.

Fifty-two patients with acute traumatic bilateral locked facets were treated at one trauma center during a 3 1/2-year period (July, 1987, to December, 1990). The patients presented with complete motor quadriplegia (34 cases), incomplete myelopathy (13 cases), or intact long-tract function (five cases). The injuries occurred at C2-3 (one patient, with intact function), C4-5 (12 patients), C5-6 (16 patients), C6-7 (19 patients), and C7-T1 (four patients). Immediate traction (with increasing weight and serial x-ray studies) and/or induction of general anesthesia and muscle relaxation reduced the dislocation in 40 patients, but 12 needed prompt operative reduction as their injuries failed to reduce within 4 hours. Stabilization was indicated for all patients, but three did not undergo surgery: two elderly patients with complete injuries (one refused surgery and one died), and one patient with multiple injuries (fusion was achieved by halo-vest immobilization for 3 months). Of the 49 patients treated operatively, 23 (44.2%) underwent surgery on the day of injury and 26 on a delayed basis (mean 8.7 days postinjury). Surgical treatment included fusion of the posterior facet to a spinous process (44 cases), an anterior Caspar plate technique (three cases), and both procedures (two cases). Of these 49 patients, three (6.1%) with complete injuries died due to an adult respiratory distress syndrome. Improvement of cord function, judged by functional grade change, was observed at discharge in 15 patients (31.9%) and in 15 (71.4%) of the 21 patients with a 1-year follow-up period. Of the 34 patients with complete myelopathy on admission, three are ambulatory after 1 year, and 13 others have gained function in at least one nerve root. It is concluded that prompt reduction (nonoperative or surgical) and internal stabilization facilitate recovery even in neurologically compromised patients, and that early operative intervention is a wiser option than conservative management. This report also documents a higher incidence of this injury without deficit (five of the 52 cases) than reported in other series.

Adult↗
PubMed1991

Anterior decompression in cervical spine trauma: does the timing of surgery affect the outcome?

To clarify the ideal timing of anterior decompression and stabilization for all patients with cervical spine trauma as well as its efficacy for patients with complete deficits, we reviewed the records of 103 consecutive patients with cervical spine trauma (50 incomplete deficits, Group A; 53 complete deficits, Group B) who underwent this procedure during a 5-year period at the Shock Trauma Center. We subdivided each group according to time of surgery: early and delayed (less than 24 and greater than 24 hours past injury, respectively). In Group A, 10 patients underwent early surgery and 40 patients underwent delayed surgery (range, 2 to 77 days past injury; mean, 13 days). One patient (2.5%) in the delayed group died. The following data refer to the early and delayed subgroups, respectively: average acute hospitalization, 20 and 22 days; patient motor score improvement (at discharge), 37.2 and 45.0%; functional grade improvement (at discharge), 5 (50.0%) and 9 (22.5%) patients. At 1-year follow-up, every patient who had had a deficit had progressed to a higher functional grade. In Group B, 35 patients underwent early surgery and 18 underwent delayed surgery (range, 2 to 45 days past injury; mean, 13 days). One patient (2.9%) in the early group died. The following data refer to the early and delayed subgroups, respectively: average acute hospitalization, 38.7 and 45.2 days (P less than 0.05); respiratory care (number of daily suction procedures), 6.0 and 9.86 (P less than 0.05); patient motor score improvement (at discharge), 3.9 and 4.5%; functional grade improvement (at discharge), 4 (11.4%) and 1 (5.6%) patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

Intermittent oscillopsia in a case of congenital nystagmus. Dependence upon waveform.

Spontaneous reports of oscillopsia are rare in cases of congenital nystagmus (CN). We examined the relationship between nystagmus waveform characteristics and oscillopsia in one such case. To reduce the patient's nystagmus, she was fitted with contact lenses. We examined the effects of tactile feedback by applying local anesthetic while she wore the lenses. When she was without lenses, we provided tactile feedback by applying gentle finger pressure to one eyelid. She was also asked to look at a peripheral afterimage. Nystagmus was analyzed for frequency, amplitude, foveation duration, and drift velocity, if foveation was not perfectly stable. Perceived target stability was recorded. The patient noted oscillopsia during the initial baseline recording and with lid pressure. The image was stable with contact lenses with and without anesthesia and during the second session baseline; at these times, drift velocity was less than 4 degrees/sec and foveation duration was greater than 100 msec. No oscillopsia of the afterimage in dark was noted; she perceived it moving with her gaze as she attempted to look at it. It appears that in some CN patients, the suppression of oscillopsia operates only within fixed limits of foveation stability and duration. When, because of internal or external factors, their nystagmus exceeds these, oscillopsia results.

Adolescent↗
PubMed1990

[Head and brain injuries in bicyclists].

44 patients were hospitalized for neurosurgical care after bicycle accidents during a period of 50 months. Ten times as many were injured in other types of road accidents. 42 of the 44 cases had brain injury, with a mean hospitalization of 9.7 days. A third needed operation and a fourth were discharged with residual neurological deficits. The low incidence of 0.95 cases per 100,000 per year led us to examine the factors which limit the use of bicycles in our region. The severity of the injuries in our cases was much greater than in those in other countries, with a mean injury severity score of 14.2. None of our cases had worn a protective helmet, and we join in the world-wide plea for an educational campaign for their use.

Bicycling↗
PubMed1990

Occupational stress. Spice of life or kiss of death?

Work-related psychosocial stressors originate in social structures and processes, affect the human organism through psychological processes, and influence health through four types of closely interrelated mechanisms--emotional, cognitive, behavioral, and physiological. The health outcome is modified by situational (e.g., social support) and individual factors (e.g., personality, coping repertoire). The work-environment-stress-health system is a dynamic one with many feedback loops. There is little but increasing direct evidence of a causal relationship between work-related psychosocial stressors and the incidence and prevalence of occupational morbidity and mortality. But, a substantial body of indirect evidence strongly suggests that such associations exist and emphasizes the need to better understand their role. Accordingly, research and health action should aim at being systems-oriented, interdisciplinary, intersectorial, health- (and not only disease-) oriented, and participative.

Accidents, Occupational↗
PubMed1990

Head trauma in northern Israel: incidence and types.

A descriptive epidemiological study of neurotraumatology was undertaken over a 4.5-year period at a regional hospital with a referral base of 1,200,000 residents served by a single neurosurgical department. Neurosurgical evaluations and treatments were given to 1,370 patients in this period. The data base consists of demographic, clinical and radiological features at the time of admission, as well as the hospital course through discharge. The crude incidence rate was 25.2 +/- 3.1 cases per 100,000 person-years (similar to that of three neurosurgical units in Scotland). Age adjustment showed almost twice this rate at the two extremes of age and a smaller elevation in early adulthood. The crude incidence was 36.9 for males and 13.4 for females (p less than 0.01). Age-specific incidence rates in Jews compared to other ethnic groups were reported. Falls had an incidence of 12.8 (51%), road accidents 9.0 (35.7%) and assaults 2.3 (9%) per 100,000 person-years. Other causes were accidents during work or sport and suicide. The rate of brain pathology as revealed by computerized tomography steadily increased from 19% in childhood to 71% in the elderly with a mean of 41.8%. A similar increasing trend with age was found in the rate of intracranial mass lesions (mean 28.3%), impaired consciousness (30.4%) and mortality (13%).

Adolescent↗
PubMed1990

Structural changes, ill health, and mortality in Sweden, 1963-1983: a macroaggregated study.

An exploratory time series analysis was performed on selected indicators of structural change, health behavior, and ill health in Sweden in the years 1963-1983. Both synchronic (nonlagged) and asynchronic (lagged) analyses were made. The synchronic analysis of variations in the suicide rate reveals two main contributory factors: level of employment and overtime work. For cardiovascular mortality in men, the synchronic and the two-year time lagged analyses reveal that the sale of alcohol and, to a certain extent, the length of the period of unemployment play a major role. In an analysis with a three-year time lag, only one significant factor for both men and women is revealed, namely the level of employment. In the synchronic analysis of cirrhosis mortality in men, the sale of alcohol plays a dominant role. The results of the synchronic analysis of the variations in sick leave show a similar pattern for both men and women. In both cases, the sale of alcohol is positively associated and the proportion of unemployed industrial workers negatively associated with sick leave. The results give rise to a number of questions. For example, how should these findings be interpreted and how should they be related to existing knowledge about the links between business cycles and changes in the health of the population? The answers to such questions are of importance both from a scientific viewpoint and with regard to health policy. We argue that the answers require further studies of the characteristics of the periods in the business cycle and of how these periods affect people's lives, living conditions, and behavioral patterns in general.

Alcohol Drinking↗
PubMed1990

Penetrating craniocerebral injuries in the Israeli involvement in the Lebanese conflict, 1982-1985. Analysis of a less aggressive surgical approach.

From June, 1982, through June, 1985, 113 patients were evacuated to Rambam Maimonides Medical Center with penetrating craniocerebral injuries sustained in ongoing military hostilities in Lebanon. Two factors distinguished this group of patients from those presenting in earlier conflicts: 1) this was the first large series in which computerized tomography (CT) was routinely used to initially evaluate combat head injuries; and 2) in an effort to preserve maximum cerebral tissue, intracranial debridement was significantly less vigorous than that advocated during the Korean or Vietnam conflicts. No efforts were made to locate or remove in-driven bone or metal fragments visualized on CT unless they readily presented themselves on gentle irrigation. In fact, it was elected to treat a number of patients without intracranial hematomas nonoperatively. The acute outcome was quite similar to that reported in Vietnam series in respect to both complications and mortality. Of the 83 survivors, 46 were Israeli citizens and thus were available for follow-up review. These 46 patients were reevaluated in late 1988, a mean follow-up period of 5.9 years. None had died in the interim; 10 had developed chronic seizure disorders, and there was one case of delayed meningitis in a patient with no retained fragments. Repeat CT scans were performed on 43 patients; 22 (51%) were found to have retained intracranial bone fragments. No relationship existed between the presence of retained fragments and the development of either a seizure disorder or an infection of the central nervous system. These findings suggest that not only is it unnecessary to reoperate for retained bone fragments, but it may also be possible to temper the initial debridement in an effort to preserve additional cerebral tissue.

Brain Injuries↗
PubMed1990

Visual illusions associated with previous drug abuse.

We describe the visual illusions experienced by five patients with a history of previous use of hallucinogens, marijuana, or both. Symptoms included shimmering of images, illusory movement of images, visual perseveration of stationary objects, streaking of moving objects, and moving objects appearing as a consecutive series of stationary images. In all cases, the symptoms had persisted or recurred after periods of drug abstinence ranging from several months to several years. Despite thorough and repeated examinations and investigations, there was no evidence of neurologic ophthalmologic disease in these patients. When patients present with these and other visual illusions, a thorough drug history may afford the answer, provided that other recognized causes of these visual symptoms, such as migraine, epilepsy, and intracranial lesions have been excluded.

Adult↗
PubMed1990

Diffuse axonal injury: analysis of 100 patients with radiological signs.

One hundred patients with head injuries who showed diffuse axonal injury on computed tomographic scans are reported. Evaluation of the Glasgow Coma Score, pupillary signs, and computed tomographic findings on admission led to an improved ability to forecast outcomes. Our relatively good results as compared with other series, can be explained by the high proportion of children and by the liberal use of computed tomography to evaluate head injuries, thus revealing that concussion may sometimes be regarded as an early form of diffuse axonal injury.

Adult↗
PubMed1990

Wartime neurosurgical experience in Lebanon, 1982-85. I: Penetrating craniocerebral injuries.

The present report analyzes 116 penetrating wounds of the brain sustained during warfare in Lebanon during 1982-85. Two basic mechanisms of injury were encountered: high-velocity bullets, and shrapnel and stones from explosive devices; and in one case a radio antenna penetrated the head through the orbit. The site of impact was at the convexity in 87% of cases and at the base of the skull in the remaining 13%. Surgery was performed in 83% of the patients: debridement-craniotomy in 73%, burr hole for intracranial pressure monitoring only in 6% and scalp closure only in 4%. The remaining 17% did not require surgery because of transbasal penetration without intracranial mass (10%) or due to moribundity. Indriven bone or foreign body fragments were removed only if readily accessible. The mortality rate was highest among patients with a Glasgow Coma Scale of less than or equal to 4 on arrival, after high-velocity bullet wounds, when the intracranial path was multilobar or transventricular, and when associated lesions were accompanied by shock. A follow-up study of the 49 Israeli survivors for almost 6 years revealed intracerebral-retained bone fragments in 48%, but these did not result in increased immediate or late complications (e.g., infection, epilepsy). These results support our conservative approach. Since all victims of penetrating head injuries were evacuated from Lebanon to Rambam Medical Center, Haifa, our report can serve as an estimation of the incidence of penetrating brain wounds and their burden on a front-line hospital.

Brain↗
PubMed1990

Wartime neurosurgical experience in Lebanon, 1982-85. II: Closed craniocerebral injuries.

This report presents 64 patients who sustained military-related closed craniocerebral injuries during the Lebanon conflict of 1982-85, all of whom underwent CT scanning at the initial assessment. Of these, 59% required surgery for removal of hematomas, depressed fractures and for monitoring intracranial pressure, in addition to intensive care management of elevated intracranial pressure and associated insults. CT scan revealed brain concussion only in 23%, depressed fracture in 9%, brain contusion alone in 17%, extracerebral hematomas in 17%, intracerebral hematomas in 11%, and diffuse axonal injury in 22%. Overall mortality was 19%, and the outcome was good in 69%. Various factors affecting survival are discussed, and our findings are compared with those in the literature concerning closed head injuries among civilians. Attention is drawn to the high proportion of diffuse brain injury due to blasts caused by side mines. Despite continued efforts to hasten evacuation from the field and improve the management of warfare-related head trauma, the outcome is still far from satisfactory.

Blast Injuries↗
PubMed1989

Occupational stressors, biological stress and workers' health.

The evidence that occupational physical stressors can cause disease--in the sense that exposure, avoidance or manipulation of them increases, decreases, or removes the risk of becoming ill, or reverses ill health when it occurs--is established for a large number of stressors and diseases. The role of occupational psychosocial stressors is not so clear. Such stressors originate in work-related social structures and processes. They affect the human organism through psychological processes. They influence workers' health and well-being through four types of closely interrelated mechanisms--emotional, cognitive, behavioral, and physiologic. The outcome is modified by situational factors (e. g., social support) and individual ones (e. g., personality characteristics and coping repertoire). The work environment-stress-health system is a dynamic one with many feedback loops. The author reviews complementary epidemiological and experimental evidence of patho- and salutogenic interactions within this system, emphasizing the importance of neuroendocrine mechanisms as well as work stress and health related behaviors. There is little direct evidence of a causal relationship between work-related social structures and processes and their change (or lack of change), and the incidence and prevalence of stress-related occupational morbidity and mortality. But, a substantial body of indirect evidence strongly suggests that such associations exist and emphasizes the need to better understand their role. Accordingly, the research approach should aim at being: systems-oriented; interdisciplinary; problem-solving oriented; health-(and not only disease-) oriented; and participative. Among those interventions for which preliminary evidence suggests the value of research are: Increasing a worker's control of the work arrangements; Providing mechanisms for worker participation in decision making on the organization of work; Avoiding monotonous, machine-paced, and short but frequent work actions; Optimizing automation; Helping workers see their specific task in relation to the total product; Avoiding quantitative work over- and underload; and Facilitating communication and support systems among work mates and others.

Health Promotion↗