Papers by Scott R Levin, M.D., M.Sc., D.A.B.S.
Journal of Vascular Surgery, 2020
impact on performance and learning during a specialty-focused workshop and post-workshop career a... more impact on performance and learning during a specialty-focused workshop and post-workshop career aspirations. Methods: Preclinical medical students self-rated fine motor skills as greater than peers ($4 of 5-point scale, high self-raters [HSRs]) vs average or below (#3, low self-raters [LSRs]) before completing six surgical, endovascular, and clinical skills stations. Students rated vascular skill set importance and career aspirations before and after the workshop using a 5-point scale. Station challenge level, amount learned, and self-performance were rated. Analysis included unpaired t-test and repeated-measures paired t-test. Results: All stations were completed by 6 HSRs and 16 LSRs. Vascular aspirations were equal before and after the session and were overall higher in HSRs than in LSRs (3.8 6 1.0 vs 2.9 6 0.6; P ¼ .01). HSRs reported more learning than LSRs in two equivalently rated stations (4.8 6 0.4 vs 4.1 6 0.7; P ¼ .02). There were no significant differences for other measures including performance. Ratings for open skill importance in vascular surgery increased from before to after the session (3.6 6 0.8 vs 4.7 6 0.5; P ¼ .0001) for all students. Conclusions: Among students with equivalent performance, HSRs were significantly more open to pursuing the vascular specialty and reported more learning during simulation than LSRs. Perceived ability may have an impact on career aspirations and self-perception of learning during surgical skill exposure. Future efforts will explore targeting and understanding LSRs to encourage recruiting these learners into surgical specialties.
Journal of Vascular Surgery, 2019
Objective: Infrainguinal peripheral vascular interventions (PVIs) can be performed with a variety... more Objective: Infrainguinal peripheral vascular interventions (PVIs) can be performed with a variety of sheath sizes. Our aim was to investigate the effect of sheath size on postprocedural complications after infrainguinal PVI. Methods: The Vascular Quality Initiative (2010-2017) was queried for patients undergoing infrainguinal PVI through retrograde common femoral artery access. Univariable and multivariable methods were performed to compare the effects of sheath size on access site complications, length of stay (LOS), and 30-day mortality. Results: Of the 36,901 infrainguinal PVI procedures in the data set, the mean age was 69 years, and 59.1% of patients were male. Indications for intervention were claudication (41.6%), rest pain (13.2%), and tissue loss (45.2%). The femoral-popliteal and tibial arteries were treated in 84.7% and 35.4% of cases, respectively. Interventions included stenting (39.2%) and atherectomy (21.3%). Sheath sizes of 7F, 6F, 5F, and 4F were used in 5225 (14.1%), 24,541 (66.5%), 6221 (16.9%), and 914 (2.5%) cases, respectively. Differences in sheath sizes were observed on the basis of ambulatory status; presence of diabetes, end-stage renal disease, previously stented ipsilateral extremities, anemia, and preprocedural anticoagulation; and procedural details, including indications, location of intervention, and intervention type (P < .001 for all). On univariable analysis, sheath size (7F vs 6F vs 5F vs 4F) was associated with differences in access site hematoma (3.5% vs 2.7% vs 2.5% vs 1.2%; P < .001), postprocedural LOS >1 day (18.1% vs 25.3% vs 31.1% vs 27.9%; P < .001), and 30-day mortality (0.9% vs 1.4% vs 1.5% vs 1.5%; P ¼ .007). There was no difference in hematoma requiring intervention or access site stenosis or occlusion based on sheath size. Multivariable analysis revealed that a larger sheath size was independently associated with access site hematoma (7F: OR,
Annals of Vascular Surgery, 2021
In 2014, in addition to male smokers aged 65-75, the U.S. Preventive Services Task Force (USPSTF)... more In 2014, in addition to male smokers aged 65-75, the U.S. Preventive Services Task Force (USPSTF) recommended abdominal aortic aneurysm (AAA) screening for male never-smokers aged 65-75 with cardiovascular risk factors (Grade C). The USPSTF evolved from a negative to neutral position on screening for female smokers aged 65-75 (Grade I). We sought to determine whether 2014 guidelines resulted in more AAA repairs in these populations. We queried the Vascular Quality Initiative national database (2013-2018) for elective endovascular aortic repairs and open aortic repairs. We implemented difference-in-differences (DID) analysis, a causal inference technique that adjusts for secular time trends, to isolate changes in repair numbers due to the 2014 USPSTF guidelines. Our DID models compared changes in repair numbers in patient groups targeted by the USPSTF updates (intervention group) to those in unaffected, older patient groups (control), before and after 2014. The first model compared changes in repair numbers between male never-smokers aged 65-75 (intervention group) and 76-85 (control). The second model compared repair numbers between female smokers aged 65-75 (intervention group) and 76-85 (control). There was no significant change in male never-smokers (n=1,295) aged 65-75 (42%) vs. 76-85 (58%) undergoing AAA repairs after guideline updates, averaged over 4.5 years (+2.4 percentage points; 95% Confidence Interval [CI] -.56-5.26). However, when their primary insurer was Medicare, male never-smokers aged 65-75 compared with 76-85 underwent significantly more repairs over 4.5 years (+3.69 percentage points; 95% CI.16-7.22; representing a 10.4% relative increase from baseline in the proportion of male never-smokers on Medicare undergoing AAA repair). Comparing female smokers (n=2,312) aged 65-75 (54%) vs. 76-85 (46%), there was no significant change in repairs over 4.5 years (-.66 percentage points; 95% CI -4.57-3.26). The USPSTF 2014 AAA guidelines were associated with modestly increased repairs in male never-smokers aged 65-75 only on Medicare. There was no impact among female smokers. Higher-grade recommendations and improved guideline adherence may be requisites for change.
Plastic and reconstructive surgery. Global open, Apr 1, 2023
Background: Identifying risk factors for traumatic lower extremity reconstruction outcomes has be... more Background: Identifying risk factors for traumatic lower extremity reconstruction outcomes has been limited by sample size. We evaluated patient and procedural characteristics associated with reconstruction outcomes using data from almost four million patients. Methods: The National Trauma Data Bank (2015–2018) was queried for lower extremity reconstructions. Univariable and multivariable analyses determined associations with inpatient outcomes. Results: There were 4675 patients with lower extremity reconstructions: local flaps (77%), free flaps (19.2%), or both (3.8%). Flaps were most commonly local fasciocutaneous (55.1%). Major injuries in reconstructed extremities were fractures (56.2%), vascular injuries (11.8%), and mangled limbs (2.9%). Ipsilateral procedures prereconstruction included vascular interventions (6%), amputations (5.6%), and fasciotomies (4.3%). Postoperative surgical site infection and amputation occurred in 2% and 2.6%, respectively. Among survivors (99%), mean total length of stay (LOS) was 23.2 ± 21.1 days and 46.8% were discharged to rehab. On multivariable analysis, vascular interventions prereconstruction were associated with increased infection [odds ratio (OR) 1.99, 95% confidence interval (CI) 1.05–3.79, P = 0.04], amputation (OR 4.38, 95% CI 2.56–7.47, P &lt; 0.001), prolonged LOS (OR 1.59, 95% CI 1.14–2.22, P = 0.01), and discharge to rehab (OR 1.49, 95% CI 1.07–2.07, P = 0.02). Free flaps were associated with prolonged LOS (OR 2.08, 95% CI 1.74–2.49, P &lt; 0.001). Conclusions: Prereconstruction vascular interventions were associated with higher incidences of adverse outcomes. Free flaps correlated with longer LOS, but otherwise similar outcomes. Investigating reasons for increased complication and healthcare utilization likelihood among these subgroups is warranted.
Annals of Vascular Surgery, 2021
INTRODUCTION Penetrating injuries to the inferior vena cava (IVC) and/or iliac veins are a source... more INTRODUCTION Penetrating injuries to the inferior vena cava (IVC) and/or iliac veins are a source of hemorrhage but may also predispose patients to venous thromboembolism (VTE). We sought to determine the relationship between iliocaval injury, VTE and mortality. METHODS The National Trauma Data Bank was queried for penetrating abdominal trauma from 2015-2017. Univariate analyses compared baseline characteristics and outcomes based on presence of iliocaval injury. Multivariable analyses determined the effect of iliocaval injury on VTE and mortality. RESULTS Of 9,974 patients with penetrating abdominal trauma, 329 had iliocaval injury (3.3%). Iliocaval injury patients were more likely to have a firearm mechanism (83% vs. 43%, P<0.001), concurrent head (P=0.036), spinal cord (P<0.001), and pelvic injuries (P<0.001), and higher total injury severity score (median 20 vs. 8.0, P<0.001). They were more likely to undergo 24-hour hemorrhage control surgery (69% vs. 17%, P<0.001), but less likely to receive VTE chemoprophylaxis during admission (64% vs. 68%, P=0.04). Of patients undergoing iliocaval surgery, 64% underwent repair, 26% ligation, and 10% unknown. Iliocaval injury patients had higher rates of VTE (12% vs. 2%), 24-hour mortality (23% vs. 2.0%) and in-hospital mortality (33% vs. 3.4%) (P<0.001 for all). VTE rates were similar following repair (14%) and ligation (17%). Iliocaval injury patients also had higher rates of cardiac complications (10.3% vs. 1.4%), acute kidney injury (8.2% vs. 1.3%), extremity compartment syndrome (4.0 vs. 0.2%), and unplanned return to OR (7.9% vs. 2.5%) (P<0.001 for all). In multivariable analyses, iliocaval injury was independently associated with risk of VTE (OR 2.12; 95% CI, 1.29-3.48; P = 0.003), and in-hospital mortality (OR = 9.61; 95% CI, 4.96-18.64; P < 0.001). CONCLUSION Iliocaval injuries occur in <5% of penetrating abdominal trauma but are associated with more severe injury patterns and high mortality rates. Regardless of repair type, survivors should be considered high risk for developing VTE.
Journal of Vascular Surgery, 2020
Journal of Vascular Surgery, 2018
to compare rates to identify risk factors and outcomes of restenosis between CEA and CAS.
Journal of Vascular Surgery, 2019
Objective: Infrainguinal peripheral vascular interventions (PVIs) can be performed with a variety... more Objective: Infrainguinal peripheral vascular interventions (PVIs) can be performed with a variety of sheath sizes. Our aim was to investigate the effect of sheath size on postprocedural complications after infrainguinal PVI. Methods: The Vascular Quality Initiative (2010-2017) was queried for patients undergoing infrainguinal PVI through retrograde common femoral artery access. Univariable and multivariable methods were performed to compare the effects of sheath size on access site complications, length of stay (LOS), and 30-day mortality. Results: Of the 36,901 infrainguinal PVI procedures in the data set, the mean age was 69 years, and 59.1% of patients were male. Indications for intervention were claudication (41.6%), rest pain (13.2%), and tissue loss (45.2%). The femoral-popliteal and tibial arteries were treated in 84.7% and 35.4% of cases, respectively. Interventions included stenting (39.2%) and atherectomy (21.3%). Sheath sizes of 7F, 6F, 5F, and 4F were used in 5225 (14.1%), 24,541 (66.5%), 6221 (16.9%), and 914 (2.5%) cases, respectively. Differences in sheath sizes were observed on the basis of ambulatory status; presence of diabetes, end-stage renal disease, previously stented ipsilateral extremities, anemia, and preprocedural anticoagulation; and procedural details, including indications, location of intervention, and intervention type (P < .001 for all). On univariable analysis, sheath size (7F vs 6F vs 5F vs 4F) was associated with differences in access site hematoma (3.5% vs 2.7% vs 2.5% vs 1.2%; P < .001), postprocedural LOS >1 day (18.1% vs 25.3% vs 31.1% vs 27.9%; P < .001), and 30-day mortality (0.9% vs 1.4% vs 1.5% vs 1.5%; P ¼ .007). There was no difference in hematoma requiring intervention or access site stenosis or occlusion based on sheath size. Multivariable analysis revealed that a larger sheath size was independently associated with access site hematoma (7F: OR,
Journal of Vascular Surgery, 2019
Objectives: Beacon Tip (Cook Medical, Bloomington, Ind) catheter is a common type of angiographic... more Objectives: Beacon Tip (Cook Medical, Bloomington, Ind) catheter is a common type of angiographic catheter. On April 15, 2016, the U.S. Food and Drug Administration (FDA) issued an unclassified recall owing to complaints of tip splitting and/or fracture. The Manufacturer and User Facility Device Experience (MAUDE) Database was established by the FDA to allow for voluntarily reporting of adverse outcomes with medical devices. We set forth to examine how reports to the MAUDE changed before and after this catheter recall. Methods: The MAUDE database was accessed in December 2018 for all MAUDE entrees for the Beacon Tip 2 years before and after the recall. The database was searched for days to report from index date, catheter French size, delayed in presentation, if additional procedure was undertaken, and if material was left in the patient. The threshold for an additional procedure was defined as any intervention requiring a new site of entry for removal of foreign material. Results: A total of 144 entries were examined: 64 before the recall (44.4%) and 80 after the recall (55.6%; Table). Conclusions: In examining the MAUDE database, we have found there were more entries after the FDA recall. There were fewer delayed presentations and material left in the patient in the postrecall period. There was no statistically significant change in the French size, days to report or additional procedures in comparing the time periods. These data are encouraging in terms practitioners' responsible behavior after an endovascular catheter recall as captured by this national complication database.
Journal of the American College of Surgeons, 2018
Objective: Radial artery-based wrist arteriovenous fistulas (AVFs) are commonly created as an ini... more Objective: Radial artery-based wrist arteriovenous fistulas (AVFs) are commonly created as an initial upper extremity arteriovenous access. A more distal access site, such as the anatomic snuffbox AVF, can also be created. Although much has been written about wrist AVFs, outcomes of snuffbox AVFs are unclear. Our goal was to compare perioperative and midterm outcomes between these two types of distal access. Methods: The Vascular Quality Initiative database was queried for all patients undergoing snuffbox AVFs and wrist AVFs from 2011 to 2017. Unmatched and matched analyses were performed for baseline characteristics and outcomes at 6 months for ischemic steal, wound infection, and arm swelling. Multivariable analysis was performed for unmatched and matched analyses for primary patency, surgical or endovascular repair, and patient survival. Kaplan-Meier matched analysis was performed for primary patency, freedom from surgical or endovascular intervention, and survival. Results: We identified 4525 distal forearm fistulas: 179 (4%) snuffbox AVFs and 4346 (96%) wrist AVFs. The average age was 59 6 14.7 years, and 72.3% of patients were male. There were no significant differences in baseline demographics or comorbidities of patients with snuffbox AVFs and wrist AVFs except that patients with snuffbox AVFs had fewer tunneled lines at access creation (70.2% vs 65.2%; P ¼ .046) and had a lower American Society of Anesthesiologists class. There were no significant differences in unmatched outcomes at 6 months for ischemic steal (0.8% vs 1.9%; P ¼ .336), wound infection (0% vs 0.2%; P ¼ .649), and arm swelling (0.8% vs 1.3%; P ¼ .592). Matched analysis showed no significant differences in baseline characteristics and outcomes at 6 months for ischemic steal (0% vs 1.8%; P ¼ .146), wound infection (0% vs 0%), and arm swelling (0.9% vs 1.2%; P ¼ .789). Kaplan-Meier matched analysis showed no significant differences between snuffbox AVFs and wrist AVFs at 6 months for primary patency (51% vs 48%; P ¼ .61), freedom from endovascular intervention (84.5% vs 82.5%; P ¼ .98), freedom from surgical intervention (90% vs 86%; P ¼ .08), and survival (92% vs 96%; P ¼ .1). In multivariable analysis of unmatched data, snuffbox AVFs and wrist AVFs had similar primary patency (hazard ratio [HR], 0.97; 95% confidence interval [
Journal of Vascular Surgery, 2020
Journal of Vascular Surgery, 2019
Objective: Acute mesenteric ischemia (AMI) is a life-threatening condition associated with dismal... more Objective: Acute mesenteric ischemia (AMI) is a life-threatening condition associated with dismal outcomes. This study sought to evaluate the evolution of presentation, treatment, and outcomes in AMI patients during the past two decades. Methods: Patients who presented with AMI from 1993 to 2015 across three institutions were reviewed. Primary outcome was 30-day mortality. Univariate and multivariate analysis were performed. Results: There were 305 patients identified. AMI mechanisms included embolic (49%), thrombotic (28%), and nonocclusive (22%). The majority were women (55%), 50% had atrial fibrillation, and 41% had a procedure within 30 days of presentation. Mean age was 72 6 13 years. There were 244 patients who underwent operative exploration: 225 open vs 19 hybrid/endovascular. Among patients explored, 32% (n ¼ 77) underwent a second-look procedure; the majority of these patients (n ¼ 49/77 [64%]) required either additional revascularization or bowel resection at time of second-look surgery. The 30-day mortality was 60% (n ¼ 182). In comparing patients who presented before 2004 with those who presented after, 30-day mortality was similar (before 2004, 62%; after 2004, 58%; P ¼ .47), but anticoagulation use was more prevalent in the contemporary cohort (10% vs 34%; P < .001). There was a trend toward embolic events representing fewer AMI cases over time: 52% to 45%. Up to one in three operations had findings of nonsurvivable bowel necrosis before 2004, and this decreased to one in five after 2004. Predictors of 30-day mortality included an admission white blood cell count $23,000/m 3 (odds ratio [OR], 2.8; P ¼ .02) and coronary disease (OR, 2.1; P ¼ .01); anticoagulation use was protective (OR, 0.24; P ¼ .001). Predictors of nonsurvivable bowel necrosis included embolic event (OR, 4.4; P ¼ .001) and chronic kidney disease (OR, 4.9; P ¼ .003); white blood cell count and lactate concentration were not predictive. Conclusions: Despite advances in critical care during the past 25 years, AMI continues to be associated with poor prognosis. Fewer patients with nonsurvivable bowel necrosis are being operated on, suggesting improvement in clinician prognostication. However, contemporary rates of 30-day mortality remain high at 58%. The significant percentage of patients requiring intervention on second-look procedures suggests this practice is prudent. Better guidelines for and compliance with anticoagulation appear to contribute to decreasing embolic events causing AMI.
Journal of Vascular Surgery, 2019
unplanned shunting (intraoperatively indicated; Fig). Univariable and multivariable analyses were... more unplanned shunting (intraoperatively indicated; Fig). Univariable and multivariable analyses were performed on the basis of shunting method. Results: There were 5683 CEAs performed within 14 days of ipsilateral stroke. Shunting cohorts included none (38.4%), planned (56.1%), and unplanned (5.5%). They differed by rates of severe contralateral carotid stenosis (6.9% vs 8.8% vs 6.8%), general anesthesia use (89.1% vs 97.5% vs 89%), and conventional CEA technique (81% vs 94% vs 87.7%; P < .05 for all). Unadjusted outcomes significantly differed for operative duration (122.6 6 47.5 minutes vs 124.3 6 48.1 minutes vs 130.3 6 42.8 minutes) and 30-day stroke (2.4% vs 3.4% vs 7.1%; P < .05 for all). There was no difference in mortality or myocardial infarction. On multivariable analysis, 30-day stroke was associated with unplanned (odds ratio [OR], 3.36; 95% confidence interval [CI], 1.87-6.04; P < .001) and planned (OR, 1.53; 95% CI, 1.02-2.3; P ¼ .04) shunting relative to no shunting. However, subgroup analysis revealed no significant difference between no shunting and routine shunting for 30-day stroke. Furthermore, nonroutine compared with routine shunting predicted increased 30-day stroke (OR, 1.76; 95% CI, 1.23-2.53; P ¼ .002). Prior coronary revascularization independently predicted increased unplanned shunting (OR, 1.37; 95% CI, 1.05-1.8; P ¼ .022). Conclusions: In CEAs performed after acute ipsilateral stroke, no shunting was associated with relatively low perioperative stroke risk. Unplanned and planned shunting predicted increased risk of stroke; however, shunting by nonroutine shunters may account for this difference.
Journal of Vascular Surgery, 2019
We studied patients in the Vascular Quality Initiative registry who were 65 years or older and un... more We studied patients in the Vascular Quality Initiative registry who were 65 years or older and underwent open surgical (OPEN) or endovascular (EVR) AAA repair between 2003 and 2015. Patients were linked to Medicare claims (90% matched) to study long-term outcomes through September 30, 2015. Using Kaplan-Meier survival analysis and Cox regression, we explored the effect of sex (men vs women) on repeat repair (any repeat OPEN or EVR procedure), aneurysm rupture, abdominal intervention, and all-cause mortality. All analyses were stratified by AAA repair type (EVR vs OPEN) and adjusted for patient risk factors, disease severity, and center-level variation. Results: Our cohort included 17,067 eligible patients, of which 22% were women. We studied long-term outcomes up to 10 years postprocedure (median follow-up, 2.0 years; interquartile range, 0.94-3.40 years). EVR was performed more frequently than OPEN (EVR: 78% vs OPEN: 22%), but women comprised a larger proportion of the OPEN group than EVR (29% OPEN vs 20% EVR; P < .001). After risk adjustment, there were no statistically significant gender differences in long-term outcomes after OPEN (Fig). Although men had a higher rate of repeat repair (22% vs 16%; log-rank P ¼ .30) and women had a higher rate of abdominal intervention (24% vs 12%; log-rank P ¼ .05) after OPEN, these differences did not reach statistical significance. Compared with men, women undergoing EVR had higher risk-adjusted rates of aneurysm rupture (7.0% vs 2.3%; log-rank P ¼ .04) and death (71% vs 65%; log-rank P ¼ .01). In fact, multivariable Cox regression analyses reveal that women were 58% more likely to have an aneurysm rupture (hazard ratio, 1.58; 95% confidence interval, 1.01-2.46) and 10% more likely to die (hazard ratio, 1.10; 95% confidence interval, 1.01-1.21) when compared with men. Conclusions: In the decade following AAA repair, women fared similarly to men after OPEN repair. However, after EVR, women were more likely to die or suffer late aneurysm rupture. Further study is required to understand why gender disparities occur in outcomes after EVR.
Journal for Learning through the Arts: A Research Journal on Arts Integration in Schools and Communities
Objectives: The humanities, including narrative arts, are a valuable tool to foster reflection fo... more Objectives: The humanities, including narrative arts, are a valuable tool to foster reflection for professionally competent clinical practice. Integrating such study into traditional medical school curricula can prove challenging. A preclinical elective on opera and medicine was developed and piloted at the Warren Alpert Medical School of Brown University for pre-medical and medical students to foster reflective capacity supporting professional identity formation. Methods: Interdisciplinary faculty from the departments of arts and sciences conducted nine facilitated discussion sessions. A field trip to the Metropolitan Opera, NY complemented students' operatic studies. Students were asked reflection-inviting questions concerning their emotional response to operatic scenes, characters, and physician-patient interactions throughout the course and given opportunities to discuss how opera reflects and reinforces stereotypes and societal stigma of patients, diseases, and physicians. A final reflective paper prompted analysis of more and less successful patient-provider interactions, exploring how students felt about these relationships, and drawing conclusions about how they would like to ideally act in the future. Formative feedback was provided using a reflection rubric. Results: Course evaluations demonstrated that sessions were well received. Students' qualitative comments described the influence of the course on the development of their professional identities, as well as the potential impact on their future careers as physicians. Lessons learned and future directions are suggested. Conclusions: This novel curriculum can serve as a model for using opera to enhance reflection and foster professional identity formation at other health profession and liberal arts institutions.
Columbia University, 2012
This is the first study to examine Antonio Vivaldi's opera, Orlando finto pazzo, in relation to i... more This is the first study to examine Antonio Vivaldi's opera, Orlando finto pazzo, in relation to its source text, Matteo Boiardo's masterpiece, Orlando innamorato. The intent of this analysis is to revive interest in a work that was overshadowed by the critically acclaimed Giovanni Ristori opus, Orlando furioso. While the librettist Grazio Braccioli preserves familiar traits of Boiardo's protagonists, he inventively develops their strengths and weaknesses to the audience's delight. Orlando, who remains hopelessly clueless about his adored Angelica's nefarious motives, nevertheless eventually wises up to his former mistress Origille's pattern of treachery.
Thesis Chapters by Scott R Levin, M.D., M.Sc., D.A.B.S.
Columbia University, 2012
Elsa Morante’s melodramatic and Gothic novel, Menzogna e sortilegio (Lies and Sorcery), published... more Elsa Morante’s melodramatic and Gothic novel, Menzogna e sortilegio (Lies and Sorcery), published in 1948, was set in a modern, yet antiquated Sicily, and achieved critical success despite its refutation of the neorealistic style of the day. Morante, who herself loathed reality, evokes her prototype in the protagonist and narrator Elisa de Salvi, whose character falls prey to the same menzogne and romantic delusions as her family. The novel was translated in an abridged version into English by Adrienne Foulke and published in the United States under the title, House of Liars (1951). The American publisher omitted an entire chapter in Part VI of House of Liars, perhaps because it interrupts the linearity of the plot and returns the reader to the present time and space, in which the narrator, Elisa, addresses herself and her reader. In this autonomous and metanarrative chapter, Elisa and her act of writing become the protagonists of the novel.
Given the approaching centennial of Morante’s birthday, it is appropriate that we celebrate and provide a contemporary English translation of the missing chapter, which omission in her own words “massacred” the novel, rendering it “unrecognizable.” Through her alter-ego Elisa, Morante allows the reader to witness the tortuous process of writing and editing a literary work. While she privileges us with this metanarrative technique, she deprives us of key elements of the story. Her clever circumlocutory technique leaves us in a state of pleasurable mystification. This breakthrough passage, herein translated into English, serves as an integral part of Morante’s legacy of experimenting with the narrative voice and reinventing the Romance genre.
articles by Scott R Levin, M.D., M.Sc., D.A.B.S.
Journal of Vascular Surgery
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Papers by Scott R Levin, M.D., M.Sc., D.A.B.S.
Thesis Chapters by Scott R Levin, M.D., M.Sc., D.A.B.S.
Given the approaching centennial of Morante’s birthday, it is appropriate that we celebrate and provide a contemporary English translation of the missing chapter, which omission in her own words “massacred” the novel, rendering it “unrecognizable.” Through her alter-ego Elisa, Morante allows the reader to witness the tortuous process of writing and editing a literary work. While she privileges us with this metanarrative technique, she deprives us of key elements of the story. Her clever circumlocutory technique leaves us in a state of pleasurable mystification. This breakthrough passage, herein translated into English, serves as an integral part of Morante’s legacy of experimenting with the narrative voice and reinventing the Romance genre.
articles by Scott R Levin, M.D., M.Sc., D.A.B.S.
Given the approaching centennial of Morante’s birthday, it is appropriate that we celebrate and provide a contemporary English translation of the missing chapter, which omission in her own words “massacred” the novel, rendering it “unrecognizable.” Through her alter-ego Elisa, Morante allows the reader to witness the tortuous process of writing and editing a literary work. While she privileges us with this metanarrative technique, she deprives us of key elements of the story. Her clever circumlocutory technique leaves us in a state of pleasurable mystification. This breakthrough passage, herein translated into English, serves as an integral part of Morante’s legacy of experimenting with the narrative voice and reinventing the Romance genre.