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Levinson S, Pendharkar AV, Gauden AJ, Heit JJ. Modern Imaging of Aneurysmal Subarachnoid Hemorrhage. Radiol Clin North Am 2023; 61:457-465. [PMID: 36931762 DOI: 10.1016/j.rcl.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
In this review, we discuss the imaging of aneurysmal subarachnoid hemorrhage (SAH). We discuss emergency brain imaging, aneurysm detection techniques, and the management of CTA-negative SAH. We also review the concepts of cerebral vasospasm and delayed cerebral ischemia that occurs after aneurysm rupture and their impact on patient outcomes. These pathologies are distinct, and the use of multimodal imaging modalities is essential for prompt diagnosis and management to minimize morbidity from these conditions. Lastly, new advances in artificial intelligence and advanced imaging modalities such as PET and MR imaging scans have been shown to improve the detection of aneurysms and potentially predict outcomes early in the course of SAH.
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Affiliation(s)
- Simon Levinson
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Arjun V Pendharkar
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Andrew J Gauden
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Jeremy J Heit
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA; Stanford School of Medicine, 453 Quarry Road, Palo Alto, CA 94304, USA.
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Avecillas-Chasin JM, Levinson S, Kuhn T, Omidbeigi M, Langevin JP, Pouratian N, Bari A. Author Correction: Connectivity-based parcellation of the amygdala and identification of its main white matter connections. Sci Rep 2023; 13:5495. [PMID: 37015960 PMCID: PMC10073221 DOI: 10.1038/s41598-023-32200-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023] Open
Affiliation(s)
- Josue M Avecillas-Chasin
- Department of Neurosurgery, University of Nebraska Medical Center, 988437 Nebraska Medical Center, Omaha, NE, 68198-8437, USA.
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
| | - Simon Levinson
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Taylor Kuhn
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA
| | - Mahmoud Omidbeigi
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Jean-Philippe Langevin
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Neurosurgery Service, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Nader Pouratian
- Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Ausaf Bari
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
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Avecillas-Chasin JM, Levinson S, Kuhn T, Omidbeigi M, Langevin JP, Pouratian N, Bari A. Connectivity-based parcellation of the amygdala and identification of its main white matter connections. Sci Rep 2023; 13:1305. [PMID: 36693904 PMCID: PMC9873600 DOI: 10.1038/s41598-023-28100-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 01/12/2023] [Indexed: 01/25/2023] Open
Abstract
The amygdala plays a role in emotion, learning, and memory and has been implicated in behavioral disorders. Better understanding of the amygdala circuitry is crucial to develop new therapies for these disorders. We used data from 200 healthy-subjects from the human connectome project. Using probabilistic tractography, we created population statistical maps of amygdala connectivity to brain regions involved in limbic, associative, memory, and reward circuits. Based on the amygdala connectivity with these regions, we applied k-means clustering to parcellate the amygdala into three clusters. The resultant clusters were averaged across all subjects and the main white-matter pathways of the amygdala from each averaged cluster were generated. Amygdala parcellation into three clusters showed a medial-to-lateral pattern. The medial cluster corresponded with the centromedial and cortical nuclei, the basal cluster with the basal nuclei and the lateral cluster with the lateral nuclei. The connectivity analysis revealed different white-matter pathways consistent with the anatomy of the amygdala circuit. This in vivo connectivity-based parcellation of the amygdala delineates three clusters of the amygdala in a mediolateral pattern based on its connectivity with brain areas involved in cognition, memory, emotion, and reward. The human amygdala circuit presented in this work provides the first step for personalized amygdala circuit mapping for patients with behavioral disorders.
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Affiliation(s)
- Josue M Avecillas-Chasin
- Department of Neurosurgery, University of Nebraska Medical Center, 988437 Nebraska Medical Center, Omaha, NE, 68198-8437, USA. .,Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
| | - Simon Levinson
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Taylor Kuhn
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA
| | - Mahmoud Omidbeigi
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Jean-Philippe Langevin
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.,Neurosurgery Service, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Nader Pouratian
- Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Ausaf Bari
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
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Levinson S, Miller M, Iftekhar A, Justo M, Arriola D, Wei W, Hazany S, Avecillas-Chasin JM, Kuhn TP, Horn A, Bari AA. A structural connectivity atlas of limbic brainstem nuclei. Front Neuroimaging 2023; 1:1009399. [PMID: 37555163 PMCID: PMC10406319 DOI: 10.3389/fnimg.2022.1009399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 12/13/2022] [Indexed: 08/10/2023]
Abstract
Background Understanding the structural connectivity of key brainstem nuclei with limbic cortical regions is essential to the development of therapeutic neuromodulation for depression, chronic pain, addiction, anxiety and movement disorders. Several brainstem nuclei have been identified as the primary central nervous system (CNS) source of important monoaminergic ascending fibers including the noradrenergic locus coeruleus, serotonergic dorsal raphe nucleus, and dopaminergic ventral tegmental area. However, due to practical challenges to their study, there is limited data regarding their in vivo anatomic connectivity in humans. Objective To evaluate the structural connectivity of the following brainstem nuclei with limbic cortical areas: locus coeruleus, ventral tegmental area, periaqueductal grey, dorsal raphe nucleus, and nucleus tractus solitarius. Additionally, to develop a group average atlas of these limbic brainstem structures to facilitate future analyses. Methods Each nucleus was manually masked from 197 Human Connectome Project (HCP) structural MRI images using FSL software. Probabilistic tractography was performed using FSL's FMRIB Diffusion Toolbox. Connectivity with limbic cortical regions was calculated and compared between brainstem nuclei. Results were aggregated to produce a freely available MNI structural atlas of limbic brainstem structures. Results A general trend was observed for a high probability of connectivity to the amygdala, hippocampus and DLPFC with relatively lower connectivity to the orbitofrontal cortex, NAc, hippocampus and insula. The locus coeruleus and nucleus tractus solitarius demonstrated significantly greater connectivity to the DLPFC than amygdala while the periaqueductal grey, dorsal raphe nucleus, and ventral tegmental area did not demonstrate a significant difference between these two structures. Conclusion Monoaminergic and other modulatory nuclei in the brainstem project widely to cortical limbic regions. We describe the structural connectivity across the several key brainstem nuclei theorized to influence emotion, reward, and cognitive functions. An increased understanding of the anatomic basis of the brainstem's role in emotion and other reward-related processing will support targeted neuromodulatary therapies aimed at alleviating the symptoms of neuropsychiatric disorders.
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Affiliation(s)
- Simon Levinson
- Department of Neurosurgery, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, United States
- Stanford Department of Neurosurgery, Stanford University, Palo Alto CA, United States
| | - Michelle Miller
- Department of Neurosurgery, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, United States
| | - Ahmed Iftekhar
- Department of Neurosurgery, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, United States
| | - Monica Justo
- Department of Neurosurgery, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, United States
| | - Daniel Arriola
- Department of Neurosurgery, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, United States
| | - Wenxin Wei
- Department of Neurosurgery, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, United States
| | - Saman Hazany
- Department of Radiology, VA Greater Los Angeles Healthcare System, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | | | - Taylor P. Kuhn
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - Andreas Horn
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt–Universität zu Berlin, Berlin, Germany
- Department of Neurology, Center for Brain Circuit Therapeutics, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, United States
- Massachusetts General Hospital Neurosurgery and Center for Neurotechnology and Neurorecovery (CNTR) at MGH Neurology Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Ausaf A. Bari
- Department of Neurosurgery, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, United States
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Chasin JA, Levinson S, Khun T, Omidbeigi M, Pouratian N, Langevin JP, Bari A. ID:16202 Tractography-Based Parcellation of the Amygdala. Neuromodulation 2022. [DOI: 10.1016/j.neurom.2022.02.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Levinson S, Kumar KK, Wang H, Tayyar R, Dunning M, Toland A, Budvytiene I, Vogel H, Chang A, Banaei N, Shuer L. Balamuthia mandrillaris brain infection: a rare cause of a ring-enhancing central nervous system lesion. Illustrative case. Journal of Neurosurgery: Case Lessons 2022; 3:CASE2268. [PMID: 36303497 PMCID: PMC9379710 DOI: 10.3171/case2268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 02/23/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND An 80-year-old man presented with subacute mental status change, dizziness, and left-sided vision loss. Magnetic resonance imaging demonstrated a ring-enhancing right parietooccipital lesion. OBSERVATIONS Biopsy and laboratory testing demonstrated an amoebic Balamuthia mandrillaris infection. Fewer than 200 cases of this infection have been recognized in the United States, and no standardized treatment regimen currently exists. LESSONS Rapid antimicrobial therapy with miltefosine, azithromycin, fluconazole, flucytosine, sulfadiazine, and albendazole was initiated. The pathophysiology, diagnosis, and management of this infection and the patient’s course were reviewed. The importance of biopsy for pathologic and laboratory diagnosis and rapid treatment initiation with a multidisciplinary team was reinforced.
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Affiliation(s)
| | | | | | - Ralph Tayyar
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Palo Alto, California
| | - Megan Dunning
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Palo Alto, California
| | | | | | | | - Amy Chang
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Palo Alto, California
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Peeters S, Levinson S, Wahjoepramono EJ, July J. A case series and review of the mononostril endoscopic transnasal transsphenoidal approach: Safe and effective in a low resource setting. Clin Neurol Neurosurg 2021; 202:106499. [PMID: 33493882 DOI: 10.1016/j.clineuro.2021.106499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/09/2021] [Accepted: 01/12/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND A transnasal transsphenoidal (TNTS) approach can be performed through a binostril or mononostril technique. The binostril technique is generally preferred, however the mononostril may be an underutilized approach with significant benefits. METHODS All (n = 521) pituitary adenoma transsphenoidal surgeries performed from March 2008 until July 2017 at a university hospital in Indonesia were isolated. The majority (n = 512) were performed through a mononostril approach with no nasal speculum by a single experienced neurosurgeon. A PubMed literature review researching the differences in indications, techniques, and outcomes for both approaches supplements the case series. The mononostril surgical technique is described in detail. RESULTS The average mononostril operating time was 105 min. The most prevalent surgical complications were CSF leak (4.1 %), diabetes insipidus (3.7 %) and cacosmia (2.1 %). Visual field deficits noted in 85 %, 89 % improved. Length of stay was less than 2 days for 90 %, with 13 ICU admissions (average one day). Recurrence rate was 8.2 % at follow up (1-10 years). CONCLUSIONS Based on a literature review, binostril TNTS surgeries have longer operative time and a higher risk of epistaxis. According to our experience, post-operative patient comfort and satisfaction are higher with the monostril approach. Furthermore, this technique is easier to teach, ENT assistance unnecessary, and thus especially advantageous in low resource settings. Our CSF leak and tumor recurrence rates were lower than reported binostril rates in the literature. The mononostril technique is both safe and effective and should be strongly considered for an appropriately pre-selected subset of pituitary adenomas.
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Affiliation(s)
- Sophie Peeters
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Simon Levinson
- David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Eka J Wahjoepramono
- Department of Neurosurgery, Universitas Pelita Harapan, Siloam Hospital Lippo Village, Tangerang, Banten, 15811, Indonesia
| | - Julius July
- Department of Neurosurgery, Universitas Pelita Harapan, Siloam Hospital Lippo Village, Tangerang, Banten, 15811, Indonesia.
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Bari AA, Sparks H, Levinson S, Wilson B, London ED, Langevin JP, Pouratian N. Amygdala Structural Connectivity Is Associated With Impulsive Choice and Difficulty Quitting Smoking. Front Behav Neurosci 2020; 14:117. [PMID: 32714164 PMCID: PMC7351509 DOI: 10.3389/fnbeh.2020.00117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 06/11/2020] [Indexed: 11/24/2022] Open
Abstract
Introduction: The amygdala is known to play a role in mediating emotion and possibly addiction. We used probabilistic tractography (PT) to evaluate whether structural connectivity of the amygdala to the brain reward network is associated with impulsive choice and tobacco smoking. Methods: Diffusion and structural MRI scans were obtained from 197 healthy subjects (45 with a history of tobacco smoking) randomly sampled from the Human Connectome database. PT was performed to assess amygdala connectivity with several brain regions. Seed masks were generated, and statistical maps of amygdala connectivity were derived. Connectivity results were correlated with a subject performance both on a delayed discounting task and whether they met specified criteria for difficulty quitting smoking. Results: Amygdala connectivity was spatially segregated, with the strongest connectivity to the hippocampus, orbitofrontal cortex (OFC), and brainstem. Connectivity with the hippocampus was associated with preference for larger delayed rewards, whereas connectivity with the OFC, rostral anterior cingulate cortex (rACC), and insula were associated with preference for smaller immediate rewards. Greater nicotine dependence with difficulty quitting was associated with less hippocampal and greater brainstem connectivity. Scores on the Fagerstrom Test for Nicotine Dependence (FTND) correlated with rACC connectivity. Discussion: These findings highlight the importance of the amygdala-hippocampal-ACC network in the valuation of future rewards and substance dependence. These results will help to identify potential targets for neuromodulatory therapies for addiction and related disorders.
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Affiliation(s)
- Ausaf A Bari
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, United States
| | - Hiro Sparks
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, United States
| | - Simon Levinson
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, United States
| | - Bayard Wilson
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, United States
| | - Edythe D London
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States
| | - Jean-Philippe Langevin
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, United States
| | - Nader Pouratian
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, United States
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Levinson S, Tran CH, Barry J, Viker B, Levine MS, Vinters HV, Mathern GW, Cepeda C. Paroxysmal Discharges in Tissue Slices From Pediatric Epilepsy Surgery Patients: Critical Role of GABA B Receptors in the Generation of Ictal Activity. Front Cell Neurosci 2020; 14:54. [PMID: 32265658 PMCID: PMC7099654 DOI: 10.3389/fncel.2020.00054] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 02/24/2020] [Indexed: 01/04/2023] Open
Abstract
In the present study, we characterized the effects of bath application of the proconvulsant drug 4-aminopyridine (4-AP) alone or in combination with GABAA and/or GABAB receptor antagonists, in cortical dysplasia (CD type I and CD type IIa/b), tuberous sclerosis complex (TSC), and non-CD cortical tissue samples from pediatric epilepsy surgery patients. Whole-cell patch clamp recordings in current and voltage clamp modes were obtained from cortical pyramidal neurons (CPNs), interneurons, and balloon/giant cells. In pyramidal neurons, bath application of 4-AP produced an increase in spontaneous synaptic activity as well as rhythmic membrane oscillations. In current clamp mode, these oscillations were generally depolarizing or biphasic and were accompanied by increased membrane conductance. In interneurons, membrane oscillations were consistently depolarizing and accompanied by bursts of action potentials. In a subset of balloon/giant cells from CD type IIb and TSC cases, respectively, 4-AP induced very low-amplitude, slow membrane oscillations that echoed the rhythmic oscillations from pyramidal neurons and interneurons. Bicuculline reduced the amplitude of membrane oscillations induced by 4-AP, indicating that they were mediated principally by GABAA receptors. 4-AP alone or in combination with bicuculline increased cortical excitability but did not induce seizure-like discharges. Ictal activity was observed in pyramidal neurons and interneurons from CD and TSC cases only when phaclofen, a GABAB receptor antagonist, was added to the 4-AP and bicuculline solution. These results emphasize the critical and permissive role of GABAB receptors in the transition to an ictal state in pediatric CD tissue and highlight the importance of these receptors as a potential therapeutic target in pediatric epilepsy.
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Affiliation(s)
- Simon Levinson
- IDDRC, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Conny H Tran
- IDDRC, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Joshua Barry
- IDDRC, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Brett Viker
- IDDRC, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Michael S Levine
- IDDRC, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Harry V Vinters
- Section of Neuropathology, Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.,Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Gary W Mathern
- IDDRC, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.,Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Carlos Cepeda
- IDDRC, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
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Avecillas-Chasin JM, Justo M, Levinson S, Koek R, Krahl SE, Chen JW, Lee SJ, Langevin JP, Bari A. Structural correlates of emotional response to electrical stimulation of the amygdala in subjects with PTSD. Brain Stimul 2019; 13:424-426. [PMID: 31884187 DOI: 10.1016/j.brs.2019.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 12/09/2019] [Indexed: 11/28/2022] Open
Affiliation(s)
| | - Monica Justo
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Simon Levinson
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Ralph Koek
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA; Psychiatry Service VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Scott E Krahl
- Research Service, VA Greater Los Angeles Healthcare System. Department of Neurosurgery David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - James Wy Chen
- Department of Neurology David Geffen School of Medicine, University of California Los Angeles. Neurological Service, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Seung Jin Lee
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Jean-Philippe Langevin
- Department of Neurosurgery David Geffen School of Medicine, University of California Los Angeles. Neurosurgery Service, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Ausaf Bari
- Department of Neurosurgery David Geffen School of Medicine, University of California Los Angeles. Neurosurgery Service, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
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Cepeda C, Levinson S, Nariai H, Yazon VW, Tran C, Barry J, Oikonomou KD, Vinters HV, Fallah A, Mathern GW, Wu JY. Pathological high frequency oscillations associate with increased GABA synaptic activity in pediatric epilepsy surgery patients. Neurobiol Dis 2019; 134:104618. [PMID: 31629890 DOI: 10.1016/j.nbd.2019.104618] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 08/22/2019] [Accepted: 09/19/2019] [Indexed: 11/25/2022] Open
Abstract
Pathological high-frequency oscillations (HFOs), specifically fast ripples (FRs, >250 Hz), are pathognomonic of an active epileptogenic zone. However, the origin of FRs remains unknown. Here we explored the correlation between FRs recorded with intraoperative pre-resection electrocorticography (ECoG) and spontaneous synaptic activity recorded ex vivo from cortical tissue samples resected for the treatment of pharmacoresistant epilepsy. The cohort included 47 children (ages 0.22-9.99 yr) with focal cortical dysplasias (CD types I and II), tuberous sclerosis complex (TSC) and non-CD pathologies. Whole-cell patch clamp recordings were obtained from pyramidal neurons and interneurons in cortical regions that were positive or negative for pathological HFOs, defined as FR band oscillations (250-500 Hz) at ECoG. The frequency of spontaneous excitatory and inhibitory postsynaptic currents (sEPSCs and IPSCs, respectively) was compared between HFO+ and HFO- regions. Regardless of pathological substrate, regions positive for FRs displayed significantly increased frequencies of sIPSCs compared with regions negative for FRs. In contrast, the frequency of sEPSCs was similar in both regions. In about one third of cases (n = 17), pacemaker GABA synaptic activity (PGA) was observed. In the vast majority (n = 15), PGA occurred in HFO+ areas. Further, fast-spiking interneurons displayed signs of hyperexcitability exclusively in HFO+ areas. These results indicate that, in pediatric epilepsy patients, increased GABA synaptic activity is associated with interictal FRs in the epileptogenic zone and suggest an active role of GABAergic interneurons in the generation of pathological HFOs. Increased GABA synaptic activity could serve to dampen excessive excitability of cortical pyramidal neurons in the epileptogenic zone, but it could also promote neuronal network synchrony.
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Affiliation(s)
- Carlos Cepeda
- IDDRC, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA.
| | - Simon Levinson
- IDDRC, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
| | - Hiroki Nariai
- Division of Pediatric Neurology, Mattel Children's Hospital, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
| | - Vannah-Wila Yazon
- IDDRC, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
| | - Conny Tran
- IDDRC, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
| | - Joshua Barry
- IDDRC, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
| | - Katerina D Oikonomou
- IDDRC, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
| | - Harry V Vinters
- Section of Neuropathology, Department of Pathology and Laboratory Medicine and Department of Neurology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
| | - Aria Fallah
- Department of Neurosurgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
| | - Gary W Mathern
- IDDRC, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA; Department of Neurosurgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
| | - Joyce Y Wu
- Division of Pediatric Neurology, Mattel Children's Hospital, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
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12
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Cepeda C, Levinson S, Yazon VW, Barry J, Mathern GW, Fallah A, Vinters HV, Levine MS, Wu JY. Cellular antiseizure mechanisms of everolimus in pediatric tuberous sclerosis complex, cortical dysplasia, and non-mTOR-mediated etiologies. Epilepsia Open 2018; 3:180-190. [PMID: 30564777 PMCID: PMC6293070 DOI: 10.1002/epi4.12253] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2018] [Indexed: 11/25/2022] Open
Abstract
The present study was designed to examine the potential cellular antiseizure mechanisms of everolimus, a mechanistic target of rapamycin (mTOR) pathway blocker, in pediatric epilepsy cases. Cortical tissue samples obtained from pediatric patients (n = 11, ages 0.67–6.75 years) undergoing surgical resections for the treatment of their pharmacoresistant epilepsy were examined electrophysiologically in ex vivo slices. The cohort included mTOR‐mediated pathologies (tuberous sclerosis complex [TSC] and severe cortical dysplasia [CD]) as well as non–mTOR‐mediated pathologies (tumor and perinatal infarct). Bath application of everolimus (2 μm) had practically no effect on spontaneous inhibitory postsynaptic activity. In contrast, long‐term application of everolimus reduced spontaneous excitatory postsynaptic activity, burst discharges induced by blockade of γ‐aminobutyric acid A (GABAA) receptors, and epileptiform activity generated by 4‐aminopyridine, a K+ channel blocker. The antiseizure effects were more pronounced in TSC and CD cases, whereas in non–mTOR‐mediated pathologies, the effects were subtle at best. These results support further clinical trials of everolimus in mTOR pathway–mediated pathologies and emphasize that the effects require sustained exposure over time.
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Affiliation(s)
- Carlos Cepeda
- IDDRC Semel Institute for Neuroscience and Human Behavior UCLA School of Medicine University of California Los Angeles Los Angeles California, U.S.A
| | - Simon Levinson
- IDDRC Semel Institute for Neuroscience and Human Behavior UCLA School of Medicine University of California Los Angeles Los Angeles California, U.S.A
| | - Vannah-Wila Yazon
- IDDRC Semel Institute for Neuroscience and Human Behavior UCLA School of Medicine University of California Los Angeles Los Angeles California, U.S.A
| | - Joshua Barry
- IDDRC Semel Institute for Neuroscience and Human Behavior UCLA School of Medicine University of California Los Angeles Los Angeles California, U.S.A
| | - Gary W Mathern
- IDDRC Semel Institute for Neuroscience and Human Behavior UCLA School of Medicine University of California Los Angeles Los Angeles California, U.S.A.,Department of Neurosurgery David Geffen School of Medicine at University of California Los Angeles Los Angeles California, U.S.A
| | - Aria Fallah
- Department of Neurosurgery David Geffen School of Medicine at University of California Los Angeles Los Angeles California, U.S.A
| | - Harry V Vinters
- Section of Neuropathology Department of Pathology and Laboratory Medicine and Department of Neurology David Geffen School of Medicine at University of California Los Angeles Los Angeles California, U.S.A
| | - Michael S Levine
- IDDRC Semel Institute for Neuroscience and Human Behavior UCLA School of Medicine University of California Los Angeles Los Angeles California, U.S.A
| | - Joyce Y Wu
- Division of Pediatric Neurology Mattel Children's Hospital David Geffen School of Medicine at University of California Los Angeles Los Angeles California U.S.A
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Rose M, Reville MC, Iszatt A, Levinson S, Frampton I, Lask B. Deconstructing Planning Ability in Children and Adolescents with Anorexia Nervosa. Applied Neuropsychology: Child 2016; 6:297-304. [DOI: 10.1080/21622965.2016.1172312] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Mark Rose
- The Huntercombe Group, Newmarket, UK
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Marie-Claire Reville
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | - Amber Iszatt
- College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | | | - Ian Frampton
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- College of Life and Environmental Sciences, University of Exeter, Exeter, UK
- Regional Eating Disorders Service, Oslo University Hospital, Oslo, Norway
| | - Bryan Lask
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- College of Life and Environmental Sciences, University of Exeter, Exeter, UK
- Regional Eating Disorders Service, Oslo University Hospital, Oslo, Norway
- Care UK, Colchester, UK
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Levinson S, Weinstein M, Abraham A, German U, Gorelik V, Rozenfeld R, Hillel S, Rodnay G. A robotic manipulator for handling TLD badges. Health Phys 2008; 95:S190-S193. [PMID: 18849713 DOI: 10.1097/01.hp.0000324207.16467.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
A prototype system for automatic handling of Harshaw/Bicron (now ThermoFisher Scientific) thermoluminescent dosimetry (TLD) badges, which is based on a robotic arm, was designed and built. The robot performs the loading and unloading of the TLD cards in the badges and transports them between the loading/unloading station and magazine stations. For quality assurance, a sticker containing the worker's details printed in barcode format was added to the badge. Automatic on-line identification is performed for checking the correlation between the badge and the TLD card number.
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Affiliation(s)
- S Levinson
- Radiation Safety Department, Nuclear Research Center Negev, Beer-Sheva, Israel.
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Kravchik T, Levinson S, Oved S, Tsroya S, Pelled O, Haim M, German U. Determination of radioiodine activity in charcoal cassettes. Appl Radiat Isot 2008; 66:972-5. [DOI: 10.1016/j.apradiso.2008.02.043] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
PURPOSE The purpose of this report is to present a case of multifocal osteosarcoma in a patient with Fanconi anemia. PATIENTS AND METHODS A nine year old girl with known Fanconi anemia presented with a pathologic femur fracture. Imaging studies confirmed soft tissue and bony involvement in the femur, ipsilateral tibia, and possibly contralateral femur. RESULTS Biopsy and subsequent amputation confirmed the presence of classic osteosarcoma in the involved femur and ipsilateral tibia. The patient died seven months later of pulmonary failure secondary to metastases. CONCLUSION Fanconi anemia is known to be associated with malignancies such as leukemias. We report a new association of Fanconi anemia with osteosarcoma.
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Affiliation(s)
- S Levinson
- Oregon Health Sciences University, Portland, USA
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Polesky A, Farber HW, Gottlieb DJ, Park H, Levinson S, O'Connell JJ, McInnis B, Nieves RL, Bernardo J. Rifampin preventive therapy for tuberculosis in Boston's homeless. Am J Respir Crit Care Med 1996; 154:1473-7. [PMID: 8912767 DOI: 10.1164/ajrccm.154.5.8912767] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
An epidemic of isoniazid (INH)- and streptomycin (SM)-resistant tuberculosis began among Boston's homeless population in 1984. Individuals with skin test conversions who agreed to preventive therapy received either INH, rifampin, or a combination of INH and rifampin. A total of 204 individuals with documented tuberculin skin test conversions who did not have active tuberculosis at the time of the clinical evaluation for their positive skin test were eligible for preventive therapy. Data on type and length of preventive therapy were obtained from the Tuberculosis Clinic and the Boston Tuberculosis Registry records at Boston City Hospital. The individuals were followed for development of active tuberculosis. Six of 71 (8.6%) individuals who received no therapy, 3 of 38 (7.9%) in the INH group, and none in the rifampin or rifampin plus INH groups (49 and 37 persons, respectively) developed active tuberculosis. Patients in the rifampin group were significantly less likely to develop tuberculosis than patients in the no therapy group (p = 0.04; odds ratio [OR] = 0.00, 95% confidence interval [CI] = 0.00-0.91). Treatment with any rifampin-containing preventive therapy (rifampin or rifampin plus INH) was effective (p < 0.01 ) in preventing development of active disease. The three INH failures were with organisms that were resistant to INH.
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Affiliation(s)
- A Polesky
- Department of Medicine, Boston University School of Medicine, Massachusetts, USA
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Liu K, Levinson S. Comparisons of blood pressure between Asian-American children and children from other racial groups in Chicago. Public Health Rep 1996; 111 Suppl 2:65-7. [PMID: 8898780 PMCID: PMC1381671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
RESEARCHERS COMPARED AVERAGE BLOOD PRESSURE, prevalence of elevated blood pressure, and average anthropometric measurements of Asian children with those same measures in children from other racial and ethnic groups, including blacks, whites, and Hispanics. The sample consisted of 1318 boys and 1548 girls ages 6 to 9 who had complete blood pressure and anthropometric data, which were derived from a health screening program in nonpublic schools conducted by the Chicago Department of Health from 1975 to 1978. The systolic pressure, adjusted for age, weight, and height, for Asian, black, Hispanic, and white boys was 108.1, 105.8, 104.7, and 105.6 mmHg, and for diastolic pressure, the adjusted values were 59.6, 58.9, 56.3, and 57.4 mmHg. For both systolic and diastolic, the differences between Asian boys and white boys and between Asian boys and Hispanic boys were statistically significant. For girls, the results were similar. In addition, for boys, the prevalence rates of elevated blood pressure (systolic greater than or equal to 122 mmHg or diastolic greater than or equal to 78 mmHg) were similar among the four groups. For girls, the prevalence rate for Asians was higher than those in the other groups; however, the differences were not statistically significant. Since hypertension is a major health problem in Asians, it is important to confirm these findings and to understand why mean blood pressure adjusted for age and body size is higher in Asian children than in other racial groups.
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Affiliation(s)
- K Liu
- Department of Preventive Medicine, School of Medicine, Northwestern University, Chicago, IL 60611, USA
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Cole R, Hirschman L, Atlas L, Beckman M, Biermann A, Bush M, Clements M, Cohen L, Garcia O, Hanson B, Hermansky H, Levinson S, McKeown K, Morgan N, Novick D, Ostendorf M, Oviatt S, Price P, Silverman H, Spiitz J, Waibel A, Weinstein C, Zahorian S, Zue V. The challenge of spoken language systems: Research directions for the nineties. ACTA ACUST UNITED AC 1995. [DOI: 10.1109/89.365385] [Citation(s) in RCA: 72] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
Associations between blood pressures and three indices commonly used to assess relative obesity (weight (kg)/height (m)2, weight (kg)/height (m)3, and weight (kg)/height (m)p) were examined in a multiracial sample of children attending private schools in Chicago, Illinois. The 1,723 boys and 1,878 girls were 5-10 years old at the time of the survey (1975-1978). Inclusion of white, black, Hispanic, and Asian children permitted comparison of the relation between anthropometric variables and blood pressures across racial groups. The three weight-for-height indices used as estimates of relative obesity yielded nearly identical regression models, suggesting that, in spite of ongoing debate about the most appropriate index for describing relative obesity in children, it makes little difference which index is used.
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Affiliation(s)
- C Ballew
- Department of Community Health and Preventive Medicine, Northwestern University Medical School, Chicago, IL
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Smith LC, Minehart RC, Ashery D, Piasetsky E, Moinester M, Navon I, Geesaman DF, Schiffer JP, Stephens G, Zeidman B, Levinson S, Mukhopadhyay S, Segel RE, Anderson B, Madey R, Watson J, Whitney RR. Reaction 3He( pi +,pp)p at T pi =350 and 500 MeV. Phys Rev C Nucl Phys 1989; 40:1347-1362. [PMID: 9966109 DOI: 10.1103/physrevc.40.1347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Levinson S, Liu K, Stamler J, Stamler R, Whipple I, Ausbrook D, Berkson D. Ethnic differences in blood pressure and heart rate of Chicago school children. Am J Epidemiol 1985; 122:366-77. [PMID: 4025287 DOI: 10.1093/oxfordjournals.aje.a114117] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
In 1975-1978, the Chicago Department of Health conducted a screening program that included measurements of blood pressure, heart rate, height, weight, triceps skinfold thickness, and arm circumference, and calculation of body mass index and muscle circumference for non-public school children. Based on data on 4,086 boys and girls aged 5-10 years from the program, this study examined the ethnic differences in blood pressure and heart rate among children of white, black, Latino, and Oriental ethnicity. Mean levels for both systolic and diastolic blood pressure were higher for Oriental and black children than for white and Latino children. These differences were independent of age, height, weight, and skinfold thickness. The black children had a much lower mean heart rate than the other children. A seasonal variation was observed for systolic blood pressure, i.e., with each sex group, the mean systolic blood pressure adjusted for age, skinfold thickness, and height tended to be higher in spring than in fall and winter. (Note-- no child was screened during the summer because of summer break.) With control for season, ethnic differences in systolic blood pressure disappeared, but not the ethnic differences in diastolic blood pressure and heart rate.
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Rabiner L, Levinson S. A speaker-independent, syntax-directed, connected word recognition system based on hidden Markov models and level building. ACTA ACUST UNITED AC 1985. [DOI: 10.1109/tassp.1985.1164586] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Abstract
Eating a 1000-kcal mixed meal stimulates an increase in distal colonic motility. Fat is the dietary component which is the major stimulant of colonic spike activity. In this study the colonic spike activity increased similarly after the mixed meal [19.1 +/- 2.4 spike potentials (SP)/30 min] and after the fat meal (19.4 +/- 5.4 SP/30 min). Fat stimulated a concentration-dependent increase in colonic motility only when in contact with the gastroduodenal mucosa. Intravenous administration of Liposyn (100 kcal/hr) did not stimulate an increase in colonic spike activity (3.3 +/- 1.3 SP/30 min) despite greater increase in plasma total fatty acid levels than after the oral ingestion of fat. In contrast both the oral ingestion and the intravenous administration of an amino acid mixture (Aminosyn) inhibited the gastrocolonic response after the 1000-kcal mixed meal. Thus, these studies demonstrate: (1) fat stimulates colonic motility only through direct mucosal contact, and (2) a mixture of amino acid inhibits colonic motility through either mucosal contact or by circulating in the plasma. The exact neurohumoral mechanisms involved in both of these effects is unknown at present.
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Smith GA, Levinson S. Pressure equalization tube tympanoplasty. Ear Nose Throat J 1983; 62:75-7. [PMID: 6832032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
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Levinson S. Under cover: the hidden costs of infiltration. Hastings Cent Rep 1982; 12:29-37. [PMID: 7129624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Abstract
Scores on the Children's Personality Questionnaire (CPO) were correlated with ratings on the Devereux Elementary School Behavior Rating Scale (DESB). Three judges matched scales from the two instruments that appeared to measure the same behavior. For about one-third of these matches significant correlations in the predicted direction were found. Of the 156 possible correlations between CPQ factors and DESB scales 50 reaches significance. The results contradict those of a similar investigation (Willis & Sevmour, 1978), whose methodology is questioned. The correlations found in the present study provide limited support for the validity of CPQ factors.
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Abstract
This study explored the association between sodium excretion and blood pressure (BP). A new method was used to minimize the measurement error introduced by the large intrinsic variability of 24-hour sodium excretion. The ratio of intra- to interindividual variation was used to estimate the number of measurements needed to characterize the individual. When seven consecutive 24-hour samples were collected from 73 children, ages 11-14 years, a significant correlation between mean individual sodium excretion and BP was demonstrated. The independent relationship persisted when controlling for height, weight, pulse, age, sex and race (p = 0.045), but was eliminated by simultaneously considering mean creatinine excretion. Although the cross-sectional association described is quantitatively weak, a linear relationship between BP and sodium over the range consumed in this society could be important for prevention.
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Abstract
Angiographic examination in a patient with sciatic-like pain on the right side and a firm, pulsatile, non-tender mass in the right buttock revealed a large sciatic artery aneurysm. The aneurysm was successfully resected at surgery. The primitive sciatic artery is the main arterial supply to the lower extremities in the 9-mm embryo. Its persistence, while very rare, is of clinical significance because of the tendency for aneurysms to develop in the artery. Surgical resection is indicated in sciatic artery aneurysms because of the danger of rupture or embolic occlusion of arteries distal to the aneurysm.
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Abstract
Pseudomyotonia is a syndrome characterized by progressive muscle stiffness, weakness, myokymia, hyperhydrosis, and wasting of muscle. It especially affects the distal aspect of the extremities. The electromyogram is characteristic, and shows continuous muscle activity at rest. We discuss a case that is believed to be the first recorded instance of pseudomyotonia complicated by airway obstruction secondary to laryngeal spasm. Treatment with phenytoin sodium resulted in rapid improvement of the peripheral symptoms and simultaneous resolution of the laryngeal spasm.
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Raskin NH, Levinson S, Hoffman PM, Pickett JB, Fields HL. Postsympathectomy neuralgia. Amelioration with diphenylhydantoin and carbamazepine. Am J Surg 1974; 128:75-8. [PMID: 4834899 DOI: 10.1016/0002-9610(74)90238-4] [Citation(s) in RCA: 54] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Pernick BJ, Levinson S, Bartolotta C. Enhancement of low spatial frequency signals with optical aperture tapering. Appl Opt 1970; 9:1902-1905. [PMID: 20094160 DOI: 10.1364/ao.9.001902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Detection of weak signals in an optical spectrum analyzer is impaired by sidelobes from nearby large signal components in the output spectrum. Strong sidelobes about the zero frequency component particularly inhibit detection of low frequency signals. Sidelobe response can be attenuated by suitable illumination tapering over the input data aperture. Changes of first and second sidelobe levels and main lobe width have been investigated for gaussian, lorentzian, and exponential tapers. Improved capability to distinguish weak low frequency signals in the presence of distortions introduced by component flaws is demonstrated for the exponential form.
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Vidne B, Levinson S, Levy MJ. Venous pressure monitor. Surgery 1970; 67:279-80. [PMID: 5411290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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