Search PubMed⌕ Search

Biomedical subjects

N Levi

Publications and source records attributed to N Levi.

At least 19 recordsLinked to original sources
PubMed2000

Primary closure of deep sternal wound infection following open heart surgery: a safe operation?

BACKGROUND: Deep median sternotomy wound infection is a significant source of morbidity and mortality after cardiac operations. Management of an infected median sternotomy incision is a subject of controversy. The aim of this study was to assess our experience with primary closure without any irrigation system for infected deep median sternotomy wound. METHODS: Between January 1994 and December 1997, 4,227 consecutive open heart procedures via a median sternotomy under cardiopulmonary bypass were performed in our department. A total of 27 (0.64%) consecutive patients with deep sternotomy wound infection were identified. The mean age of the patients was 45 years. Six were female and 21 were male. RESULTS: The incidence of deep sternal wound infection was therefore 0.64%. The mean duration between the primary operation and the onset of deep sternal wound infection was 2.5 weeks. Staphylococcus aureus and Staphylococcus epidermidis were the most common pathogen causing postoperative mediastinal infection. Out of the 27 cases, 17 were successfully treated, 8 (30%) died and 2 had a persistent fistula. The mean follow-up time was 18 months (range 4 to 52 months). The mortality in the pediatric group was 4/8 (50%) and 4/19 (21%) in the adult group. The mortality for mediastinitis presenting before one week or after 4 weeks after operation was 63%. In contrast, the mortality for mediastinitis presenting after one week but before 4 weeks after operation was 17%. CONCLUSIONS: Mediastinitis after cardiac surgical procedures remains a devastating complication. Primary closure without irrigation-suction system should only be considered in selected patients.

Adolescent↗
PubMed1999

Storage of viruses on filter paper for genetic analysis.

The purpose of this study was to develop a method to store viruses on filter paper without the need for special conditions for future use of the genetic material. Two non-enveloped viruses were used as models. Infectious bursal disease virus (IBDV), a double-stranded RNA virus that infects chickens, belongs to the Birnaviridae family. Hemorrhagic enteritis virus (HEV), with double-stranded DNA, belongs to the Adenoviridae family. Three different solutions were found suitable for loading the virus. The viruses were stored at room temperature or at 37 degrees C for periods of 5-30 days. Direct reverse transcription-polymerase chain reaction (RT-PCR) (without previous extraction of the RNA) was carried out on filter paper loaded with IBDV, and fragments of the expected size were detected. HEV DNA was extracted from filter paper loaded with purified virus or crude tissue. PCR fragments were found to be of similar intensity to those of control virus that was kept in a tube at -20 degrees C. This method permits the storage and transport of viruses from the field or from clinics to a regional laboratory or any laboratory elsewhere, without the need for prior treatment or special environmental conditions.

Animals↗
PubMed1999

True and anastomotic femoral artery aneurysms: is the risk of rupture and thrombosis related to the size of the aneurysms?

OBJECTIVE: the management of asymptomatic femoral aneurysms remains controversial. The purpose of this study was to investigate the relation between the diameter of true and anastomotic aneurysms and the risk of rupture. DESIGN: retrospective study. MATERIAL AND METHODS: we reviewed the case records of 17 patients who underwent 17 arterial reconstructive procedures for true femoral aneurysms. In addition, the case records of 76 patients who underwent 90 arterial reconstructive procedures for femoral anastomotic aneurysms were identified and reviewed. RESULTS: the rupture rate for aneurysms less than 5 cm in diameter was 1.6% (one out of 64) compared with 16% (seven out of 43) for those larger than 5 cm. The thrombosis rate for aneurysms less than 5 cm in diameter was 17% compared with 5% for those larger than 5 cm. CONCLUSIONS: this study seems to show that the risk of rupture of femoral artery aneurysms is related to the diameter of the aneurysms. However, the rise in the risk of rupture with increasing size seems less dramatic than for abdominal aortic aneurysm (AAA).

Adult↗
PubMed1999

Thoracic disc herniation. Unilateral transpedicular approach in 35 consecutive patients.

BACKGROUND: Thoracic disc herniation is uncommon and surgery for thoracic disc herniation represents less than 1-2% of operations for disc disease. However, there is no consensus on the best approach and reports are based on small series. METHODS: A consecutive series of 35 thoracic disc herniations (25 in women and 10 in men) were treated between 1991 and 1996 using the transpedicular approach and followed in a prospective study. All patients had a preoperative MRI examination. The mean age was 51 years. The T6-7 and T7-8 level were the most frequent localization. The interval between onset of symptoms and operation ranged from 6 weeks to 4 years with a mean of 18 months. Presenting symptoms on admission was radiculopathy in 12 patients and myelopathy in 23 patients. Severe urinary symptoms were found in 2 patients, moderate symptoms in 9 patients, mild symptoms in 3 patients and 21 patient had no urinary symptoms. RESULTS: One patient was paraplegic immediately after surgery and she made no further improvement. A good result was found in 15 patients, a fair result was found in a further 11 patients but in 8 patients the outcome was unchanged with no effect of a reoperation in two cases. No clinical or radiographic features of instability were found. The postoperative course was uneventful, except in one patient with a wound abscess leading to discitis. CONCLUSIONS: The transpedicular approach can be an effective and safe method of surgical decompression in carefully selected patients.

Adult↗
PubMed1999

Dynamic hip screw versus 3 parallel screws in the treatment of garden 1 + 2 and garden 3 + 4 cervical hip fractures.

OBJECTIVE: The main objective of this study was to evaluate the failure rate following operations of undisplaced and displaced cervical hip fractures with a dynamic hip screw compared with 3 parallel screws. DESIGN: The study was retrospective. The minimum follow-up time was 1 year. The data tta collested between January 1990 and December 1993. SETTING: University Hospitals. PATIENTS: A total of 456 patients (352 women and 104 men) with cervical hip fractures were included. The mean age was 80 years (range 51-100 years). INTERVENTION: This was internal fixation of the fractured hip with a dynamic hip screw or 3 parallel screws. MAIN OUTCOME MEASURES: Failure was defined as nonunion, fixation failure or avascular necrosis and reoperation was found indicated. The 3 months mortality rate, the wound infection rate, the delay between admission and time of surgery and the blood transfusion requirement were also recorded. RESULTS: A total of 456 cervical hip fractures were operated with a dynamic hip screw or 3 parallel screws. The failure rate for fractures treated with a dynamic hip screw was 14/98 = 14% for Garden 1 + 2 fractures and 43/108 = 40% for Garden 3 + 4 fractures. The failure rate for fractures treated with 3 parallel screws was similar: 23/154 = 15% for Garden 1 + 2 fractures and 38/196 = 40% for Garden 3 + 4 fractures. The average follow-up time was 2.5 years. CONCLUSION: Operation of cervical hip fracture with a dynamic hip screw or 3 parallel screw seem to give similar results.

Aged↗
PubMed1999

False iliac artery aneurysm following renal transplantation.

We report a very rare case of a false iliac artery aneurysm following renal transplantation. The patient was a 51-year-old women who presented with a painful 10 x 10 cm pulsating mass in her left iliac fossa. The patient had received a second cadaveric renal transplantation 5 years previously. The graft never functioned and transplant nephrectomy was performed 2 weeks later. A CT-scanning showed a 10 x 10 cm large aneurysm arising from the left external iliac artery. At operation a large false aneurysm was identified arising from the original transplant anastomotic site. Due to the extent of the aneurysms, a Gortex graft was inserted between the external iliac artery and the common femoral artery. The patient made an uneventful post-operative recovery.

Aneurysm, False↗
PubMed1998

Experimental induction and termination of acute psychological stress in human volunteers: effects on immunological, neuroendocrine, cardiovascular, and psychological parameters.

The present research investigated the effects of controlled experimental manipulations of stress on biological and psychological reactions. Fifty young adult male volunteers were exposed to a 12-min period of stress induced by the threat of an unavoidable, painful electric shock. A 12-min period without this threat preceded or followed the stress period. Blood was drawn during the 4th and the 12th minute of each period. Anticipatory threat led to significant elevations in the proportions and cytotoxic activity of natural killer (NK) lymphocytes, plasma epinephrine levels, pulse rate, and reported level of tension, and to a reduction in the CD4/CD8 ratios. The no-threat period induced a return to baseline values for epinephrine, pulse rate, and tension, and lower than baseline levels for cytotoxic activity of NK lymphocytes, within a similarly short time span. The findings underline the rapidity with which physiological changes may transpire in the course of a brief and acute period of psychological stress, and the rapidity of their reversal upon relief from the stressor.

Acute Disease↗
PubMed1998

Contributions of hypoxia and respiratory disturbance index to sympathetic activation and blood pressure in obstructive sleep apnea syndrome.

Hypertension is a common finding among obstructive sleep apnea (OSA) patients, and is thought to be caused by sympathetic hyperactivity. The present study compares the contributions of the respiratory disturbance index (RDI) as a reflection of sleep fragmentation, and the magnitude of oxygen desaturation, to sympathetic activation as indexed by urinary norepinephrine concentrations, as well as to morning and evening blood pressure in sleep apnea syndrome patients. Data (polysomnography, blood pressure [BP], and urine catecholamines) of 38 consecutive OSA patients (age, 46+/-14.5 years) were analyzed. Stepwise logistic regression analysis revealed that minimal oxygen saturation level (SaO2min) was a significant predictor of both morning and evening norepinephrine levels, and that 37% of morning systolic BP variance could be accounted for by a combination of age and norepinephrine, while 20% of the diastolic BP variance was accounted for by SaO2min alone. In contrast, RDI entered the prediction equation only when minimal oxygen saturation was rejected first. Our results indicate that the degree of nocturnal hypoxia is more closely associated with the level of sympathetic activation and with daytime level of blood pressure than with sleep fragmentation.

Adult↗
PubMed1998

Isolated iliac artery aneurysms.

OBJECTIVE: To assess our experience with isolated iliac artery aneurysms and to assess the blood transfusion requirement in patients undergoing surgery for iliac artery aneurysms. MATERIAL AND METHODS: The case records of 12 patients who underwent 12 arterial reconstructive procedures for isolated iliac aneurysms from January 1989 to December 1995 were identified from our prospective vascular database and reviewed. Only patients with aneurysms limited to the common, external, or internal iliac arteries were included. RESULTS: Eleven patients had symptoms and rupture occurred in five patients. Aneurysmorrhaphy with graft interposition was the most common procedure. There was no perioperative mortality. The median transfusion requirement was 11 units per operation (range 1-30 units). The median intraoperative blood loss was 4700 ml (range < 500-13,000 ml). CONCLUSIONS: Isolated iliac aneurysm is a dangerous condition. A low perioperative mortality is possible only if large volumes of blood are available.

Aneurysm, Ruptured↗
PubMed1998

Delayed appearance of hip fractures in citizens of Bergen born in the countryside compared to cityborn.

Of a total of 1735 consecutive patients admitted to Engen Hospital in Bergen, 299 had sustained a hip fracture. A distinction was made according to sex, and according to whether the patients were born in the city of Bergen or in the surrounding rural areas. At the time of fracture, the countryborn had lived on average 51 years in Bergen. A delay in fracture appearance of approximately 3 years in the countryborn relative to the cityborn was found.

Age Factors↗
PubMed1998

Dysplasia epiphysealis hemimelica (Trevor's disease) of the distal radius.

The authors report a rare case of dysplasia epiphysealis hemimelica (DEH) or Trevor's disease of the radius in an Eskimo from Greenland. DEH is indistinguishable microscopically from osteochondroma, however its epiphyseal site of origin differentiates it from the osteochondroma, which characteristically originates in the metaphysis.

Aged↗
PubMed1998

An unnecessary femoral amputation?

Non-traumatic gas gangrene is extremely rare. It is commonly associated with perforation of an occult gastro-intestinal cancer. The patient's course is usually fulminant. We report a case of subcutaneous emphysema and myonecrosis of the lower extremity due to a perforated carcinoma of the large bowel. The diagnosis of colonic cancer was suspected but treatment was regrettably delayed leading to the perforation and subsequent lower extremity gas gangrene. The patient survived following a femoral amputation.

Abdominal Abscess↗
PubMed1998

Percutaneous recanalization of iliac artery occlusions with the Strecker stent.

Within a 3-year period a total of 16 iliac artery occlusions in 16 patients were treated with percutaneous angioplasty and stenting with the Strecker stent without adjunctive thrombolytic therapy. The length of the occlusions varied from 0.5 to 8 cm (mean 4.1 cm). The average stent diameter was 7.6 mm and the average length was 6.1 cm. Reocclusion occurred in 3 patients (two after one month and one after 11 months). One case of dissection and two cases of distal embolization to the external iliac artery were diagnosed during the procedure by an angiogram and were successfully treated by stenting. Two cases of small groin hematoma were treated conservatively.

Acute Disease↗
PubMed1998

Blood transfusion and postoperative wound infection in intracapsular femoral neck fractures.

The relationship between blood transfusion and postoperative wound infection was studied in 695 operations for cervical hip fractures. A total of 156 (22%) patients were transfused with a total of 392 units of blood. A total of 31 (4.5%) patients developed a postoperative superficial or deep wound infection. Cultures identified Staphylococcus aureus as the cause in 71% and E. coli in 9.7% of the infections. A total of 11 out of 156 (7.05%) transfused patients developed a wound infection. In contrast only 20 out of 539 (3.71%) non-transfused patients developed a wound infection (p < 0.05).

Aged↗
PubMed1998

Thoracic disk herniation in an 82-year-old patient. Treatment with the transpedicular approach.

A rare case of thoracic disk herniation in an 82-year-old female is reported. The patient was referred with a 2-month history of weakness and paresthesia of her left leg. On examination she had a severe paresis of the left leg and mild paresis of the right leg. Myelography and magnetic resonance imaging showed a T10-T11 disk herniation. The unilateral transpedicular approach was used and a large prolapse was surgically removed. The patient made an uneventful recovery and her neurologic function recovered to almost normal.

Aged↗
PubMed1998

Anastomotic femoral aneurysms: is an increase in interval between primary operation and aneurysms formation related to change in incidence?

OBJECTIVE: Anastomotic pseudoaneurysms continue to be a late complication of vascular surgery, particulary following prosthetic graft procedures. The purpose of this study was to investigate if a previously reported increase in interval between the original operation and the development of pseudoaneurysm was related to a change in incidence. DESIGN: Retrospective study. METHODS: We reviewed the records of 76 patients who presented with 90 femoral pseudo-aneurysms and underwent reconstructive procedures from January 1989 to June 1994. The median age was 69 years (range: 39-83). In the same time period all femoral artery anastomosis operations were recorded. RESULTS: The incidence of femoral pseudo-aneurysms in Copenhagen was approximately 4.3%. CONCLUSIONS: A previously reported increase in interval between primary operation and aneurysms formation was not related to a change in incidence during the same time period.

Adult↗