Search PubMed⌕ Search

Biomedical subjects

A B Lewis

Publications and source records attributed to A B Lewis.

At least 37 records · Page 2Linked to original sources
PubMed1990

Gender and schizophrenia outcome: a clinical trial of an inpatient family intervention.

Several studies document sex differences in premorbid and intermorbid role functioning, showing less functional deficit among females. The specific nature of sex differences in role functioning is still poorly understood. The purpose of the present study was to investigate sex differences in symptomatology and role functioning in a sample of 92 inpatients hospitalized for an episode of DSM-III-diagnosed schizophrenic disorder. Patients were randomized at hospital admission to either of two treatment conditions: (1) multimodal hospital treatment with the addition of an inpatient family intervention (IFI) or (2) multimodal hospital treatment without IFI. Results indicated (1) sex differences in levels of substance abuse and antisocial behavior (worse for males both at admission and followup)--dimensions of psychopathology unrelated to the core features of schizophrenia; (2) superior family and occupational functioning in females at followup; and (3) superior clinical response of females to IFI. Data on family response to IFI suggest some ameliorative effects of IFI on critical family attitudes toward female patients as well as greater family compliance with IFI treatment among the families of females. Sex differences in intermorbid family and occupational functioning and response to a family-based psychosocial intervention are discussed in light of data on rejecting family attitudes toward the patient and sex differences in symptomatology. The possible influence of sex-differentiated social role demands on response to IFI is also discussed.

Adult↗
PubMed1990

Utility of Doppler echocardiography in the evaluation of aortic homograft valved conduit function in children: need for segmental conduit interrogation.

To assess the utility of Doppler echocardiography in evaluation of aortic homograft valved conduit function, 10 consecutive pediatric patients had Doppler examination of aortic homograft valved conduits associated with follow-up cardiac catheterization. General correlation was found between the Doppler-derived peak systolic pressure gradient across the aortic homograft valved conduit and cardiac catheterization (r = 0.65, P less than 0.05, SEE = 20.5). One patient with multilevel obstruction had significant underestimation of gradient by Doppler due to incomplete segmental interrogation of the aortic homograft valved conduit. For the other nine patients with complete segmental conduit interrogation, correlation between Doppler and cardiac catheterization was excellent (r = 0.93, P less than 0.01, SEE = 10). Conduit insufficiency in nine out of ten patients was graded qualitatively using Doppler color flow mapping with excellent correlation between color flow mapping and cardiac catheterization (r s = 98). Aortic homograft valved conduit function can be accurately noninvasively assessed by Doppler but proximal, valve, and distal conduit segmental interrogation is necessary to localize site of obstruction if present, rule out multilevel obstruction, and avoid underestimation of systolic gradient.

Adolescent↗
PubMed1988

Inpatient family intervention: a randomized clinical trial. II. Results at hospital discharge.

Although family intervention is practiced in most psychiatric hospitals, to our knowledge, no adequately controlled studies of its efficacy exist. This study was designed to answer, in part, the question of the relative efficacy of hospitalization with family intervention as compared with hospitalization without family intervention for patients (1) with major psychiatric disorders, (2) in need of hospital treatment, and (3) for whom both treatments are judged clinically feasible. This article compares treatment results at the time of hospital discharge for 169 patients randomly assigned to the inpatient Family Intervention or comparison conditions. Inpatient Family Intervention had greater efficacy than the comparison treatment, mostly attributable to its effect on female patients, especially those patients (and their families) with affective disorder.

Adolescent↗
PubMed1988

Late growth changes in the craniofacial skeleton.

Analysis of serial radiographs shows that growth in the cranial base and in the mandible continues into the third decade. Variations in rate and timing are great, and the total increments after 18 years are usually small.

Adolescent↗
PubMed1988

Naloxone potentiates the plasma catecholamine response to asphyxia in the fetus.

The effect of endogenous opioid peptide blockade with naloxone on the plasma catecholamine response to asphyxia (hypoxemia + acidemia) was investigated in 6 chronically catheterized late gestation (greater than or equal to 120 days) fetal lambs in utero. Animals were assigned randomly to receive either naloxone (1 mg/kg) or saline on alternate days. Hypoxemia was produced by gradual umbilical cord compression until arterial PO2 less than 15 Torr and maintained for 15 min. This resulted in the development of acidemia as pH decreased from a baseline of 7.41 +/- 0.02 to 7.25 +/- 0.01. Fetal heart rate declined initially from 183 +/- 5 to 113 +/- 7 beats/min and then increased progressively to approach, but not return, to baseline, whereas mean arterial pressure continued to rise from 45 +/- 2 Torr throughout the 15-min observation period to a peak of 61 +/- 5 Torr. No difference was noted between control and naloxone-treated fetuses in their blood pH, PO2, PCO, heart rate or blood pressure responses to asphyxia. Plasma epinephrine concentrations increased 10-fold from 143 +/- 45 to 1391 +/- 290 pg/ml in control fetuses and from 254 +/- 58 to 6944 +/- 847 pg/ml, a 27-fold increase, in naloxone-treated fetuses (p less than 0.05). Norepinephrine levels were not significantly altered by opioid receptor blockade, increasing from 525 +/- 121 to 4138 +/- 912 pg/ml in controls and from 719 +/- 186 to 6,958 +/- 1,439 pg/ml in naloxone-treated animals. Thus, naloxone potentiates the plasma epinephrine response to asphyxia. Endogenous opioid peptides may act as modulators of the sympathoadrenal response to severe stress in the fetus.

Animals↗
PubMed1988

A randomized clinical trial of inpatient family intervention, III: Effects at 6-month and 18-month follow-ups.

This paper focuses on the follow-up results of a randomized clinical trial of inpatient family intervention (IFI) that emphasized psychoeducation. Results for the sample of 169 psychiatric patients suggested that adding family treatment to standard hospital treatment was effective; however, the statistical interactions indicated that this therapeutic effect was restricted to female patients with schizophrenia or major affective disorder. The effect of family treatment on male patients with these diagnoses was minimal or slightly negative. In a group of patients with other diagnoses, the Treatment by Sex effect was reversed: male patients did better with the family treatment.

Affective Disorders, Psychotic↗
PubMed1987

Acidemia potentiates the plasma catecholamine response to hypoxemia in fetal sheep.

Though hypoxemia has been shown to stimulate adrenal medullary catecholamine (CA) release and raise plasma CA concentrations, the extent to which concomitant acidosis influences the magnitude of this response is unclear. Eleven chronically catheterized late gestation (0.8 term) fetal lambs in utero were investigated during a baseline control period and following the onset of umbilical cord constriction-induced hypoxemia (PO2 = 5-15 Torr). Plasma CA rose in response to hypoxemia in all animals but was potentiated by the development of acidemia. Baseline norepinephrine (NE = 487 +/- 113 pg/cm3 and increased to 1,386 +/- 127 pg/cm3 (p less than 0.001) in response to hypoxemia. Hypoxemia combined with acidemia promoted an even greater rise in NE to 6,726 +/- 1,289 pg/cm3 (p less than 0.05). Plasma epinephrine (E) = 99 +/- 36 pg/cm3 during baseline observations and increased to 512 +/- 81 pg/cm3 (p less than 0.001) in response to hypoxemia. However, an additional 9-fold increase (p less than 0.05) was noted when hypoxemia was combined with acidemia (E = 4,311 +/- 1,449 pg/cm3). Thus, acidosis significantly potentiates the magnitude of the plasma CA response to hypoxemia in the late gestation fetus.

Acidosis↗
PubMed1987

Regression of coronary aneurysms in patients with Kawasaki syndrome.

Coronary aneurysms were demonstrated echocardiographically in 34 of 186 patients who presented with Kawasaki syndrome between 1979 and 1983. The aneurysms were confirmed by selective coronary angiography in 27 patients and by postmortem examination in one. The 27 surviving patients with proven aneurysms were followed for 2 to 40 months (mean 15), during which they received low dose (5 to 10 mg/kg) aspirin daily. Progressive improvement and resolution of aneurysms were observed by serial echocardiography in 18 patients and confirmed by angiography in 14. Coronary aneurysms persisted, however, in nine other patients for 14 to 40 months (mean 25.7). The incidence of aneurysm resolution was higher in children less than 1 year of age at the onset of the illness than in patients older than 1 year (100% vs 50%; p less than .001). Aneurysms were more likely to resolve in girls than in boys (100% vs 42%; p less than .001). Fusiform aneurysms tended to resolve more frequently than saccular lesions (80% vs 18%; p less than .025). Aneurysms located distally in the coronary arteries appear to regress more rapidly than proximal ones. We conclude that an age of less than 1 year at the onset of Kawasaki syndrome, female sex, and fusiform aneurysm morphology are significant factors that favor resolution of coronary artery aneurysms. However, important questions remain with regard to the long-term fate and functional capabilities of these healed lesions.

Adolescent↗
PubMed1987

Goal Attainment Scaling. Relevance and replicability in follow-up of inpatients.

First proposed by Kiresuk in 1968, Goal Attainment Scaling has been widely and enthusiastically accepted as an evaluation tool in service delivery and education. However, it has not been much used in controlled research, probably because its reliability and validity have been questioned by critics. The authors have used Goal Attainment Scaling as one of a number of outcome measures in a research project on the effect of family intervention on inpatients. In the course of doing so, they have developed guidelines for gathering information, constructing goal scales, selecting expected outcome levels, and categorizing subsequent outcome data. They believe that these guidelines have clinical integrity and that their use would improve the reliability of goal attainment scaling without detracting from its value as an individualized measure. With these modifications, Goal Attainment Scaling can be made more systematic and therefore more reliable without losing its intrinsic value as an individually targeted outcome measure.

Adult↗
PubMed1986

Radionuclide angiographic evaluation of ventricular function in isolated congenitally corrected transposition of the great arteries.

Eight asymptomatic patients (mean age 19 years, range 7 to 32) with congenitally corrected transposition of the great arteries (CCTGA) underwent equilibrium gated radionuclide angiocardiography at rest and during supine bicycle exercise to assess systemic (morphologic right) and pulmonary (morphologic left) ventricular function. Five patients had normal intracardiac hemodynamic values, 2 had trivial atrioventricular valve regurgitation and 1 patient had trivial pulmonary ventricular outflow tract obstruction. Average exercise duration was 11 +/- 1 minute, with limitation due only to fatigue. At peak exercise, heart rate increased 225% and systolic blood pressure 152% over the rest value. Pulmonary ventricular ejection fraction at rest was 51 +/- 3% (mean +/- standard error of the mean); it did not change significantly at peak stress, 53 +/- 2%. Systemic ventricular ejection fraction was 48 +/- 4% at rest and increased to 64 +/- 4% at peak exercise (p less than 0.01). Count-based volume changes for the pulmonary chamber showed no significant change in end-diastolic or systolic counts at peak exercise (109 +/- 8% and 106 +/- 9% of rest value, respectively). However, end-diastolic counts decreased 13% (87 +/- 3% of rest value) and end-systolic counts 34% (62 +/- 7% of rest value) at peak exercise in the systemic ventricle. These data suggest normal systemic and impaired pulmonary ventricular function in patients with congenitally corrected transposition of the great arteries unaccompanied by significant associated lesions. These findings have important clinical implications in the setting of complex congenital heart disease in patients in whom a morphologic right ventricle functions as the systemic pumping chamber. Despite the pulmonary ventricular dysfunction, symptoms were not apparent at rest or during exercise.

Adolescent↗
PubMed1986

Effect of endogenous opioid blockade on fetal cardiovascular and sympathoadrenal responses to hypoxemia induced by umbilical cord constriction.

The cardiovascular and plasma catecholamine responses to hypoxemia following endogenous opioid blockade were evaluated in 18 late gestation fetal lambs (0.75-0.83 gestation) in utero. Hypoxemia was produced by progressive constriction of the umbilical cord with an inflatable silicone rubber cuff while fetal heart rate, blood pressure, and arterial blood gases were monitored. Fetal arterial blood samples were obtained for plasma catecholamine analysis using a radioenzymatic method. The animals were divided into 4 experimental groups. Control animals during normoxemia and following hypoxemia are represented by groups I and III, respectively. During umbilical constriction, arterial oxygen tension declined from 21.4 +/- 0.3 to 13.4 +/- 0.3 torr (p less than 0.001, mean +/- SE) and was accompanied by an increase in blood pressure (44 +/- 1 to 53 +/- 1 torr), decrease in heart rate (176 +/- 4 to 114 +/- 4 beats/min) and rise in plasma norepinephrine (437 +/- 90 to 3,410 +/- 617 pg/ml) and epinephrine (53 +/- 10 to 1,074 +/- 325 pg/ml). Naloxone infusion had no significant effect on the fetus during either normoxemic (group II) or hypoxemic conditions (group IV). Plasma catecholamines rose less in group IV than in hypoxemic control fetuses (norepinephrine: 2,407 +/- 406 vs. 3,410 +/- 617 pg/ml; epinephrine: 966 +/- 641 vs. 1,074 +/- 305 pg/ml), but the differences were not significant (p greater than 0.2). It is concluded that endogenous opioids do not play a major role in the modulation of cardiovascular and sympathoadrenal adaptations to moderate hypoxemia in the fetus.

Animals↗
PubMed1986

Fetal cardiovascular and breathing movement responses to endogenous opiates.

Endogenous opiates have been shown to alter cardiopulmonary activity in a variety of animal models. The present investigation in fetal sheep evaluate the response of heart rate, blood pressure and breathing movements (FBM) to central nervous and intravenous meth-enkephalin and beta-endorphin. Marked bradycardia was noted within 3-5 s of intravenous meth-enkephalin administration and lasted less than 10-15 s. An 84.8 +/- 19.0% prolongation in cardiac cycle length was observed after 20 nmol/kg meth-enkephalin (p less than 0.02). In contrast, there was no significant change in heart rate following 2-50 nmol/kg beta-endorphin. The meth-enkephalin-induced slowing of heart rate was virtually eliminated by autonomic blockade with atropine or hexamethonium but merely partially blunted by naloxone. FBM were not altered by intravenous administration of either opiate. However, both meth-enkephalin and beta-endorphin produced a dramatic increase in FBM following injection into the cisterna magna. Prior to opioid administration, FBM were noted 11 +/- 1.4% of the time. Intracisternal opiates resulted in a 43.9 +/- 10.1% incidence of FBM for up to 60 min. Parasympathetic blockade with atropine had no effect on the pattern of FBM following intracisternal opiate administration whereas naloxone terminated the increased respiratory activity within 1 min. These data suggest a potential role for endogenous opiates in the modulation of fetal cardiorespiratory function.

Animals↗
PubMed1986

Right ventricular growth potential in neonates with pulmonary atresia and intact ventricular septum.

The cardiac catheterization data and angiograms of 30 infants with pulmonary atresia and intact ventricular septum were reviewed to evaluate the growth potential of the right ventricle after transventricular pulmonary valvotomy. An index of right ventricular size based upon the tricuspid valve anulus, right ventricular inlet, and right ventricular outlet dimensions was used. Fourteen infants (Group I) were treated with systemic-pulmonary arterial shunts only, whereas 16 infants (Group II) underwent pulmonary valvotomy and 14 had shunting as well. Follow-up studies demonstrated the lack of right ventricular growth in Group I (right ventricular index of 7.0 +/- 3.2 preoperatively versus 7.0 +/- 2.0 postoperatively) and persistence of severe right ventricular hypertension (systolic pressure of 121 +/- 31 versus 120 +/- 48 mm Hg). In contrast, the right ventricular cavity increased in nine of 11 Group II infants who underwent valvotomy. Right ventricular index increased from 7.7 +/- 1.6 to 11.0 +/- 3.1 (p less than 0.01) and systolic pressure fell from 132 +/- 31 to 83 +/- 50 mm Hg (p less than 0.1). Early and late mortality in Group I was 50% (7/14), whereas only three of 16 Group II infants died (p greater than 0.1). It is concluded that pulmonary valvotomy should be attempted in all neonates with pulmonary atresia and intact ventricular septum in whom an outflow tract is identified angiographically to maximize the potential for right ventricular growth and increase its functional contribution to normal circulation.

Blood Circulation↗
PubMed1985

Findings on endomyocardial biopsy in infants and children with dilated cardiomyopathy.

Fifteen infants and children with dilated cardiomyopathy underwent transvascular endomyocardial biopsy. The light and electron microscopic findings were reviewed to evaluate the presence of lymphocytes as an indicator of active myocarditis. Both ventricles were biopsied in 13 patients, and the right ventricle only was biopsied in 2. None of the endomyocardial specimens obtained by biopsy revealed an inflammatory process. Interstitial fibrosis, myofiber hypertrophy, degeneration and necrosis were found. Ultrastructural abnormalities of the mitochondria, T tubules or Z bands were noted in approximately one-third of patients. Persistent, active myocarditis is an uncommon cause of dilated cardiomyopathy in children. Immunosuppressive therapy, which may be harmful, should be considered only after myocardial inflammation has been documented by endomyocardial biopsy.

Adolescent↗
PubMed1985

A controlled evaluation of inpatient family intervention. I. Preliminary results of the six-month follow-up.

Although family intervention is practiced in most psychiatric hospitals, there are no adequately controlled studies of its efficacy. This study was designed to answer, in part, the following question: What is the relative efficacy of hospitalization with family intervention as compared with hospitalization without family intervention for patients with major psychiatric disorders who are in need of hospital treatment and for whom both treatments are judged clinically feasible? This is our first report, presenting preliminary data on six-month follow-up for the first three quarters of the total sample of 144 patients (80 with schizophrenic disorder and 64 with major affective disorder).

Adolescent↗
PubMed1985

Pubertal spurts in cranial base and mandible. Comparisons within individuals.

Serial data from cephalometric radiographs were analyzed for 34 boys and 33 girls who had cephalometric radiographs annually near each birthday from at least age 7 through 18 years. Spurts were defined for this study as increases between successive cranial base increments that exceeded 0.75mm/year in boys or 0.5mm/year in girls. The corresponding criterion for the mandible was 1.0mm/year in either sex. Pubescence was defined as the 4- year period spanning 2 years before and after peak height velocity. Spurts during pubescence were common, tending to occur about 1.6yr earlier in girls than boys. The mean increments at first pubertal spurt (FPS) and the mean sizes of FPS were about 25% to 33% greater in the boys than in the girls. The rate of growth during the year before FPS tended to be greater in the girls, while in the year after FPS it tended to be greater in the boys. The timing of FPS in either cranial base of mandible was not closely related to the onset of ossification in the ulnar sesamoid, the age at peak height velocity, or age at menarche. FPS generally occurred after the onset of ossification of the ulnar sesamoid, but before peak height velocity and menarche. There was no evidence of difference between craniofacial EPS in children who passed rapidly or slowly through pubescence, nor was any difference noted between the size of pubertal spurts in tall or short boys. larger total increments after peak height velocity were found in the short boys. Significant correlations were identified between the cranial base and the mandible in the timing but not in the magnitude of FPS. The children were approximately equally divided between those in whom cranial base spurts occurred first, those in whom mandibular spurts were first, and those in whom FPS occurred in both areas within the same annual interval.

Adolescent↗
PubMed1985

Cardiovascular and catecholamine responses to hypoxemia in chemically sympathectomized fetal lambs.

Chemical sympathectomy was achieved in 8 fetal lambs in utero by daily intravenous infusion of 6-hydroxydopamine (6HD). The dose was increased progressively until a cumulative dose of 60-70 mg/kg was reached. Adequacy of adrenergic denervation was verified by the lack of any cardiovascular response to intravenous tyramine. Plasma catecholamine concentrations in normoxemic, sympathectomized fetuses were slightly higher than controls. After 6HD norepinephrine (NE) = 313 +/- 73 pg/ml (mean +/- SEM) compared to control values of 259 +/- 25 pg/ml (NS). Epinephrine (E) = 39 +/- 15 pg/ml in 6HD fetuses versus 21 +/- 4 pg/ml in controls (NS). There was a small but significant increase in arterial blood pressure (BP) (p less than 0.05), while heart rate (HR) was unchanged. Following hypoxemia, control animals demonstrated a profound increase in plasma NE (2,461 +/- 419 pg/ml) and E (2,017 +/- 749 pg/ml) along with hypertension and bradycardia. Sympathectomized fetuses maintained the NE response to hypoxemia (NE = 1,550 +/- 261 pg/ml), but the peak E response (E = 244 +/- 42 pg/ml) was significantly reduced (p less than 0.05). HR and BP responses were similar to control animals. Therefore, generalized chemical sympathectomy in the fetal lamb in utero is useful in evaluating sympathoadrenal modulation of the fetal cardiovascular system. Despite the lack of neurosympathetic activity, the sympathectomized fetus is capable of maintaining appropriate BP responses to hypoxemia by the direct effect of hypoxemia on adrenal medullary NE release.

Animals↗