Biomedical subjects
Publications and source records attributed to C T Lewis.
A review of all the bronchopleural fistulas which developed following pulmonary resection in the Department of Cardio-Vascular and Thoracic Surgery of The London Hospital between 1953 and 1973 is presented. During this period 3150 pulmonary resections were performed for various conditions and 86 fistulas occurred, an incidence of 2-7 per cent. The aetiology, diagnosis and treatment of these fistulas are discussed.
We report two cases of unusual ureteric obstruction in patients with an excessive consumption of analgesics. In a retrospective survey of seven cases of non-malignant retroperitoneal fibrosis seen in the last 15 years it was found that four had taken excessive amounts of analgesics. A careful drug history should be taken in all patients with restroperitoneal fibrosis and ureteric obstruction.
A patient developed pulmonary damage following the insertion of a Swan-Ganz catheter into the pulmonary artery. Suggestions are made on how to avoid this complication.
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Mammalian phosphoenolpyruvate carboxykinase (PEPCK) specifically requires a guanosine or inosine nucleotide as a substrate; however, the structural basis for this nucleotide specificity is not yet known. Because affinity labels derived from guanosine have not yielded a stable, modified peptide in quantities sufficient for sequence analysis, we have investigated the utility of direct photochemical cross-linking of GTP to PEPCK in order to identify the nucleotide binding site. UV irradiation at a distance of 2 cm by a Mineralight lamp (330 microW/cm2) results in the attachment of [alpha-32P]GTP to PEPCK via a stable, covalent linkage in a reaction that is dependent upon GTP concentration and duration of irradiation. After 10 min of irradiation, more than 0.2 mol of [alpha-32P] GTP is incorporated per mole of PEPCK; under these conditions the GTP concentration required for half-maximal labeling is 69 microM. The substrates phosphoenolpyruvate, ITP, and GDP provide protection against photolabeling, as do Mn2+ and Mg2+. One major and one minor radioactive peptide derived from proteolytic digests of photolabeled PEPCK have been isolated and identified. The major modified peptide has been provisionally assigned to an acidic region near the C-terminus, and the minor peptide has been identified as Ser462-Lys471.
A portable, percutaneous, battery-operated left ventricular assist device intended for intermediate and long-term use is described. The system performed satisfactorily in vitro for periods of up to 9 months and in vivo for periods in excess of 3 months. Long-standing hypertension was observed in a 98 day implant with accompanying renal and visceral vascular changes. No evidence of peripheral thromboembolism was seen. Examination of the textured blood pump surface revealed an established biologic lining, characteristic of that previously seen in calves with some evidence of peripheral calcification.
The development of implantable left ventricular assist devices (LVADs) has almost reached the stage of providing permanent circulatory support in patients who are unsuitable for, or denied, the transplant option. As part of our ongoing haemodynamic evaluation of the Thermo Cardiosystems Inc. (Boston, USA) Mark 14 pneumatic LVAD, pressure-volume loops have been produced from in vitro studies using a modified National Heart Lung and Blood Institute (NHLBI, USA) mock circulatory loop. These studies have demonstrated that during certain phases of the pump cycle non-physiologically high and low pressures are generated within the LVAD. Such abnormal pressures may damage either the bioprosthetic valves in the LVAD or the native heart, and may have adverse effects on cardiovascular control mechanisms.
The percutaneous placement of intravascular devices creates a portal for microbial invasion that can result in local infections or septicemia. In nature, resistance to "exist site" infection in percutaneous organs, such as teeth, is prevented by a dense collagen/epithelial barrier. A new percutaneous access device has been developed that incorporates a porous polyurethane "button" at the subdermal level. This device promotes the development of a collagen/epithelial interface, thus inhibiting sinus formation. Twelve percutaneous access devices (PCADS) were implanted in calves; eight devices were utilized for venting of, and hard wire passage to, an implantable left ventricular assist device (LVAD) and served as controls. Four devices were utilized for long-term vascular access. The PCADS remained in situ for 2-127 days (mean 70). Excellent healing was apparent in all cases, and no exit site or catheter related infections occurred. Histologic examination demonstrated fibroblastic in-growth and collagen deposition within the porous polyurethane, which provides a barrier to epithelial migration and firmly anchors the device. These PCADS appear to reduce exit site infections and may improve upon currently available long-term vascular access catheters.