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Biomedical subjects

J E Lewis

Publications and source records attributed to J E Lewis.

At least 19 recordsLinked to original sources

Phase resetting and fixed-delay stimulation of a simple model of respiratory rhythm generation.

In a previous study (Lewis et al., 1990), the response of the respiratory rhythm to a perturbing stimulus was investigated using two different stimulus protocols: phase resetting and fixed-delay stimulation. The first protocol consists of measuring the effects of perturbing an oscillator at different phases of the cycle on the duration of the perturbed cycle. The resulting phase response curves (PRCs) can be used to characterize the properties of the oscillator (Winfree, 1980). A second protocol, fixed-delay stimulation, involves perturbing an oscillator at a fixed latency from the onset of the cycle, repeated every n-th cycle. If a single stimulus produces an effect that lasts longer than a single cycle, complicated responses can be expected from fixed-delay stimulation (Lewis et al., 1987). A simple three-phase model for respiratory rhythm generation based on a hypothesis by Richter and coworkers (1982, 1983, 1986) was investigated in the context of these experimental studies. Phase resetting and fixed-delay stimulation protocols were simulated in the model. PRCs of the model resemble those obtained experimentally: a phase-dependent prolongation or shortening of the inspiratory phase depending on the stimulus magnitude, and a slight prolongation of the expiratory phase. Stimuli delivered to the model repetitively during successive inspiratory periods at a fixed-delay produced various combinations of shortened and prolonged cycles, similar to those observed in the experiments. However, the marked increases in cycle duration observed in the experiments during, as well as after, stimulation were not evident in the model. These comparisons suggest that (1) PRCs may not be an adequate way to evaluate certain models of rhythmogenesis, and (2) to improve the present simplified formulation of the three-phase model of the respiratory oscillator, time-varying stimulus dependent effects should be incorporated.

Animals

A study of metastatic cancer found during inguinal hernia repair.

Among 22,816 inguinal hernia repairs done between 1950 and 1988, 15 patients (0.07%) had metastatic tumors found within their hernias. Inguinal herniation was the initial sign of cancer in six patients. A palpable inguinal mass (53%) and abdominal or groin pain (67%) were the most common presenting sign and symptom, respectively. Primary tumor sites included the gastrointestinal tract (40%), ovary (20%), prostate (13%), mesothelium (13%), and unknown sites (13%). The median patient survival was 20 months and depended on the primary tumor site. Grossly apparent inguinal hernia sac abnormalities should be examined microscopically to avoid missing the diagnosis of metastatic cancer, but routine histologic examination of all hernia sacs is not warranted.

Abdominal Neoplasms

Primary squamous cell carcinoma of the parotid gland.

We reviewed all cases of possible primary squamous cell carcinoma of the parotid gland treated at Mayo Clinic, Rochester, Minn, from 1960 through 1988. Eighteen cases of primary squamous cell carcinoma of the parotid gland were identified. We report the clinical behavior and results of treatment of these rare parotid gland neoplasms. The age at diagnosis ranged from 48 to 86 years; the majority of patients were aged 65 years or older. Half of the patients presented with an asymptomatic parotid gland mass; a painful mass occurred in 33% of patients. Facial paralysis was noted in 17%, and a neck was the presenting symptom in 11% of patients. All patients underwent parotidectomy, and all or part of the facial nerve was sacrificed in 66% of patients. A neck dissection was performed in 12 patients, five of whom had pathologic confirmation of neck metastasis. Adjunctive radiation therapy was performed in 55% of patients. The overall survival at 5 years was 50%. Deep fixation and facial nerve paralysis were associated with a poor prognosis. Most recurrences developed within 1 year of initial treatment. Regional recurrence was always associated with a rapid death. Our data suggest that aggressive treatment and early detection may result in a better prognosis than is commonly associated with these tumors.

Aged

Mixtures of synthetic peptides and dipalmitoylphosphatidylcholine as lung surfactants.

Synthetic peptides that differ in their lipid-peptide interactions were combined with dipalmitoylphosphatidylcholine (DPPC) and tested in an adult rat lavaged lung model in vitro for efficacy as totally synthetic lung surfactants. The putative amphipathic alpha-helical region of the major lung surfactant apoprotein (SP-A81-102), an analogue with increased amphipathic alpha-helical potential ([Lys88,97,Glu99,Trp102]-SP-A81-102]), and the hydrophobic peptide gramicidin D were all ineffective. Three water-soluble lipid-binding peptides that contain amphipathic alpha-helical regions were also tested. Of these, only a 24-residue amphipathic alpha-helical peptide (18As) based on the lipid-binding sequences of the plasma apolipoproteins was effective. Melittin and glucagon were ineffective. Mixtures of 18As and DPPC also restored gas exchange in an in vivo lavaged guinea pig lung model to 90-95% of its prelavage value and maintained it for at least 3 h. Mixtures of DPPC and 18As are also surface active (gamma min less than 4 mN/m in the pulsating bubble). These data demonstrate the efficacy of a combination of a single lipid and a small, water-soluble, nonhemolytic, synthetic peptide containing an amphipathic alpha-helical structure and a sequence unrelated to any of the reported lung surfactant apoprotein sequences.

1,2-Dipalmitoylphosphatidylcholine

Laryngeal amyloidosis: a clinicopathologic and immunohistochemical review.

The clinical nature of laryngeal amyloidosis has not been well established, and the natural history of the disease remains a controversial matter. To address these issues, we reviewed the clinicopathologic and immunohistochemical features of 22 cases (11 men and 11 women; mean age, 56 years) of laryngeal amyloidosis. Hoarseness was the most common symptom, and the most frequent site affected was the false vocal cords. Six patients had concomitant tracheal amyloidosis. Paraffin blocks were available for immunostaining in 20 cases. Nineteen cases were positive for amyloid P component. lambda-Light chains were detected in 12 cases and kappa-light chains in 5; three cases did not show definite light-chain staining. Ten patients underwent repeated operations for persistent or recurrent respiratory tract disease. One patient died of progressive tracheobronchial amyloidosis, but systemic amyloidosis did not develop in any of the patients. Laryngeal amyloidosis is a form of localized amyloidosis characterized by monoclonal light-chain deposition. Recurrent respiratory tract disease is not uncommon, but the usual clinical course is relatively benign.

Adult

Late anastomotic recurrence after radical resection of carcinoma of the ampulla of Vater: case report.

Although 5-year survival after radical resection for ampullary carcinoma has traditionally been regarded as a cure, recent reports have documented late recurrences from these tumors. This case report describes an anastomotic recurrence developing more than 5 years after a curative resection for ampullary carcinoma. This case report is unique in its location, unusually late development, and proposed mechanism of occurrence.

Ampulla of Vater

Phospholipase C-beta 1 is regulated by a pertussis toxin-insensitive G-protein.

Regulation of phospholipase C (PLC) by receptors is mediated either through protein tyrosine phosphorylation or by activation of GTP-binding proteins (Gp). For the latter, pertussis toxin (PT)-sensitive and -insensitive pathways have been described, indicating PLC regulation by at least two types of G-proteins. The identity of PLC isoenzymes which are regulated by either type of Gp remains to be determined. Thyrotropin-releasing hormone stimulates a PLC in GH3 cells via a PT-insensitive Gp. Reconstitution methods for the assay of the GH3-cell Gp were developed. Previously, the membrane PLC was found to be reversibly extracted from membranes by high salt and to be activated by guanosine 5'-[gamma-thio]triphosphate (GTP[S]) only when membrane-associated, suggesting that Gp was retained in salt-extracted membranes. In the present work, Gp was cholate-solubilized from PLC-deficient membranes and incorporated into phospholipid vesicles, which were found to confer GTP[S]- and AlF4(-)-stimulated activity on a solubilized membrane PLC. The reconstitution provided a direct assay for the GH3-cell Gp which was shown to be distinct from Gi, Go and Gs proteins by immunodepletion studies. Incorporation of G-protein beta-gamma subunits into phospholipid vesicles with Gp inhibited GTP[S]-stimulated activity in the reconstitution. The results indicated that Gp is a heterotrimeric G-protein with the properties expected for the PT-insensitive GH3-cell Gp protein. PLC-beta 1 was fully purified and shown to be regulated by Gp in the reconstitution. In contrast, PT-sensitive G-proteins failed to affect the activity of PLC-beta 1. The results indicate (1) that a PT-insensitive Gp regulates PLC-beta 1 and (2) that PT-sensitive and -insensitive pathways of PLC regulation employ different PLC isoenzymes as well as different G-proteins.

Animals

Acinic cell carcinoma. Clinicopathologic review.

The authors reviewed 90 cases of acinic cell carcinoma treated at the Mayo Clinic to assess long-term follow-up and to study features predictive of disease progression. Sixty-three patients (55 females and 35 males) were seen for primary treatment; 27 had recurrent disease when first evaluated. Histologically, these tumors were composed of serous acinar cells and intercalated duct-type cells. Morphologic patterns included solid, microcystic, follicular, and papillary-cystic. All patients were followed for at least 10 years or until death. Of the primary treatment group, 44% had local recurrence, 19% had metastasis, and 25% died of disease. Disease first recurred locally up to 30 years after presentation and resulted in death after as many as 38 years. Poor prognostic features include pain or fixation; gross invasion; microscopic features of desmoplasia, atypia, or increased mitotic activity; and excision as initial treatment. Neither morphologic pattern nor cell composition was a predictive feature.

Aged

Primary parotid malignancies. A clinical and pathologic review.

One hundred ninety-four patients with primary malignant tumors of the parotid gland who underwent surgery at the Mayo Clinic (1970 through 1987) are reviewed. Survival patterns were analyzed using the Kaplan-Meier product-limit method that separated histologic results into three significantly different groups. Survival rate was highest for patients with acinic cell, adenoid cystic, and low-grade mucoepidermoid carcinomas; intermediate for patients with high-grade mucoepidermoid carcinomas; and lowest for the remaining six histologic types encountered. Cox multiple linear regression was used to identify patient and tumor characteristics with greatest prognostic significance. In order of decreasing strength, regional metastatic involvement, pain, male gender, grade, stage, and advancing age all demonstrated independent prognostic significance. Fifty-three percent of patients requiring facial nerve sacrifice were asymptomatic at presentation. A high positive correlation was observed between advancing grade and stage.

Adolescent

Congenital diaphragmatic hernia beyond infancy.

Congenital diaphragmatic hernia (CDH) is a common cause of severe respiratory distress in the newborn. However, the presentation of CDH in older children and adults is rare, and, therefore, little is known concerning its symptoms, operative management, and postoperative complications. Thirteen patients (age range: 2 months to 26 years; 5 males, 8 females) presented with CDH. Four patients had right-sided hernias, eight left-sided hernias, and one bilateral hernias. Symptoms included chronic respiratory tract infections in 6 patients, vomiting in 5, weight loss in 1, severe failure to thrive in 2, and severe respiratory distress in 3; one patient was asymptomatic. Physical signs included the absence of breathing sounds or bowel sounds in the chest in eight patients, hyperresonance in one, and cachexia in two. The diagnosis was confirmed in each patient by chest roentgenogram or gastrointestinal contrast radiograph. All patients underwent immediate repair. After reduction of the viscera, 12 of 13 patients underwent primary diaphragm repair, whereas one patient required a prosthetic diaphragm patch. Twelve of 13 patients (92%) survived. Postoperatively, 7 of the 12 survivors (58%) developed severe gastric atony, and four required further operative therapy. In contrast to newborns, CDH in the older child and adult is frequently seen on the right side, rarely presents with severe respiratory distress, and is occasionally asymptomatic. Postoperative gastric atony is a major cause of morbidity, making transabdominal repair with simultaneous pyloroplasty and/or feeding jejunostomy the preferred operative approach.

Adolescent

Intervascular occlusion of canine renal, splenic, and vertebral arteries using electromagnetic field focusing (EFF) probe.

Electromagnetic field-focusing (EFF) probe is a precision surgical and interventional tool. Use of the device produces maximum temperature in excess of 1800 degrees C by convergence of radio-frequency (RF) induced eddy currents in biological tissues. Applications of the EFF probe in angioplasty, aneurysm thrombosis, and neurosurgery have been previously reported. In the present work, the EFF probe was guided under fluoroscopic control and used to occlude renal, splenic, and vertebral arteries in dogs. The occlusion was typically accomplished with about one minute of RF power application. Histology of the treated vessel three to six weeks posttreatment showed total occlusion consisting of intimal and subintimal changes and organized thrombus in the lumen. This suggests that the EFF probe in comparison with other procedures is an inexpensive, relatively safe precision interventional tool for performing an occlusion for experimental and therapeutic purposes.

Animals

Head circumference in elderly long-stay patients with schizophrenia.

The head circumference of a long-stay population with schizophrenia was compared with that of a population with dementia, matched for sex and year of birth. Schizophrenics had a smaller head circumference, even after correction for height and weight. This confirms earlier but inconclusive and controversial reports, and might be taken as supporting a neurodevelopmental hypothesis of the aetiology of schizophrenia.

Aged

Effects of exogenous monoiodotyrosine on the serum levels of anterior pituitary hormones.

Monoiodotyrosine is a tyrosine hydroxylase inhibitor. Ingestion of one gram monoiodotyrosine caused a 10,000-fold increase of serum monoiodotyrosine from basal levels of 0.69 +/- 0.20 nmol/l to a peak of 10.6 +/- 1.7 mumol/l in women and 7.1 +/- 2.3 mumol/l in men 30 min later, and the t1/2 was 45 min. Monoiodotyrosine stimulated PRL to a peak of 170 +/- 51 micrograms/l in women and 90 +/- 6 micrograms/l in men 30 min after the monoiodotyrosine peak, or 60 min after the ingestion. Other anterior pituitary hormones were unchanged. Dopamine infusion or L-dopa pretreatment attenuated the monoiodotyrosine effect. TRH exaggerated the PRL peak, and chlorpromazine did not increase but prolonged the hyperprolactinemia. These results suggest that dopamine synthesis inhibition may be the mechanism of PRL stimulation.

Adult

Urticarial vasculitis occurring in association with visceral malignancy.

This is a report of a solitary patient who had urticarial vasculitis and an adenocarcinoma of the colon. Urticarial vasculitis has not been described in association with malignancy. It is considered that tumor-associated immune complexes might have been involved in the pathogenesis of the vasculitis.

Adenocarcinoma

Extrathyroidal physiology of monoiodotyrosine in humans.

Normal serum monoiodotyrosine (MIT) levels (n = 152) were 0.69 +/- 0.20 nmol/l. There was wide variation of MIT levels in a 24-hour period without diurnal pattern, and there was no change throughout the menstrual cycle. MIT levels declined upon aging, but levels in hypo- and hyperthyroidism were not significantly different. MIT levels were detected in athyrotic patients (0.32 +/- 0.08 nmol/l). Desiccated thyroid raised the athyrotic MIT levels to the normal range, while levothyroxine did not. Diiodotyrosine (DIT) infusion caused an MIT rise which paralleled but lagged 1 h behind the DIT rise. These data suggest thyroidal as well as nonthyroidal sources of MIT, one of which is deiodination of DIT. Ingestion of 1 g MIT increased serum MIT to 10.6 +/- 1.7 mumol/l in women, and 7.1 +/- 2.3 mumol/l in men 30 min after ingestion; the serum half-life was 45 min.

Adult

Congenital bronchopulmonary malformations. Diagnostic and therapeutic considerations.

Congenital bronchopulmonary malformations are uncommon but potentially life-threatening anomalies of infants and children. Between 1970 and 1988, 45 patients from birth to 13 years of age (23 boys and 22 girls) underwent evaluation and treatment for bronchopulmonary malformations. Thirty-seven had solitary lesions: bronchogenic cyst (n = 13), cystic adenomatoid malformation (n = 9), congenital lobar emphysema (n = 6), pulmonary sequestration (n = 6), arteriovenous malformation (n = 2), and bronchial atresia (n = 1). Eight additional patients had two simultaneous abnormalities and three patients had congenital diaphragmatic hernias. Twenty-one patients had respiratory symptoms, which were severe in seven. Twelve had pulmonary infection and 10 patients were completely free of symptoms. Plain chest roentgenogram was the only diagnostic imaging performed in 11 patients. Thirteen patients underwent computed tomographic scan, but in only four was it essential for diagnosis. Prenatal ultrasonography in three patients demonstrated cystic adenomatoid malformation in two, with one false negative study. Postnatally, ultrasonography was also useful in establishing the diagnoses of cystic adenomatoid malformation and pulmonary sequestration. Thoracotomy with excision of the lesion by lobectomy or pneumonectomy resulted in survival of 42 patients (93%). Three deaths in neonates were due to pulmonary hypoplasia and hypertension. Two of them had concomitant diaphragmatic hernia; the other had a cystic adenomatoid malformation and died despite the use of postoperative extracorporeal membrane oxygenation. These data demonstrate that congenital bronchopulmonary malformations usually can be diagnosed by plain chest x-ray films. Ancillary studies such as ultrasonography or computed tomography may occasionally be necessary. Combinations of the different types of bronchopulmonary malformations occurred frequently. All lesions, including symptomatic lesions in neonates, can be managed surgically soon after diagnosis.

Adolescent