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Biomedical subjects

J E Lewis

Publications and source records attributed to J E Lewis.

At least 127 records · Page 7Linked to original sources
PubMed1985

Linear basal cell epithelioma.

A 73-year-old Celtic man presented with a linear pigmented 20-mm lesion on the left infraorbital cheek (Fig. 1). Clinical impression was pigmented basal cell epithelioma. Removal was accomplished by linear excision under local anesthesia. The wound was closed with a running 5-0 nylon subcuticular suture, which was removed 6 days postoperatively. The cosmetic result was considered excellent (Fig. 2). Microscopic examination revealed nodular masses of basal neoplastic cells in the dermis typical of basal cell epithelioma. In the tumor and in the stroma were deposits of melanin, some of which were seen in melanophages. The lateral margins and base of transverse sections through the ellipse were free of tumor.

Aged↗
PubMed1985

Therapy of acute asthma: I. Evaluation of successive bronchodilator treatments.

Ninety-one children with acute asthma were studied to determine the extent of incremental improvement in pulmonary function afforded by successive doses of subcutaneous epinephrine, and by a bronchodilator aerosol in those patients refractory to epinephrine. A significant proportion of patients (69%), as expected, responded to the first injection. Among those who did not respond to the first injection a significant proportion (30%) responded to the second injection. Markedly fewer patients responded to subsequent bronchodilator treatments, including aerosols, if they did not improve significantly after the first two treatments. Patients with higher initial peak flow rates (PEFR) generally required fewer epinephrine injections, and achieved higher maximal PEFR than those with lower initial PEFR. Most asthmatic patients who required hospital admission had lower initial peak flow rates, were less responsive to epinephrine injections, and achieved lower maximal rates than those who could be discharged home.

Acute Disease↗
PubMed1984

Management of severe gastroesophageal reflux in children.

To evaluate response to fundoplication, clinical results for 66 consecutive pediatric patients operated on for gastroesophageal reflux were retrospectively reviewed. Indications for operation were gastroesophageal reflux with apnea, repeated emesis, recurrent pneumonia, failure to thrive, stricture, and esophagitis. All patients had preoperative documentation of significant gastroesophageal reflux by either cinefluoroscopic reflux esophagogram or reflux nuclear scan. Fundoplication was effective in 56 (87%) of 64 patients. None of the patients considered to be operative failures had persistent gastroesophageal reflux. Operative failures occurred primarily in patients with gastroesophageal reflux and apnea or recurrent pneumonia. More advanced diagnostic tests, such as pH monitoring, may help to select patients whose symptoms of apnea and recurrent pneumonia are truly due to reflux. Gastroesophageal reflux produces significant morbidity in pediatric patients and is well treated operatively by fundoplication.

Child↗
PubMed1984

Immunity to human cytomegalovirus measured and compared by complement fixation, indirect fluorescent-antibody, indirect hemagglutination, and enzyme-linked immunosorbent assays.

The complement fixation test is currently the test employed most frequently to determine the presence of antibody to human cytomegalovirus. Several other techniques have been adapted for this purpose. A comparison of cytomegalovirus antibody titers was made between the complement fixation test, a commercially available enzyme-linked immunosorbent assay, an indirect immunofluorescent technique, and a modified indirect hemagglutination test. Forty-three serum samples were tested for antibodies by each of the above procedures. The enzyme-linked immunosorbent, immunofluorescent, and indirect hemagglutination assays were in close agreement on all samples tested; the titers obtained with these methods were all equal to or greater than the complement fixation titer for 38 of the 41 samples (92.6%). Two samples were anticomplementary in the complement fixation test but gave readable results in the other tests. The complement fixation test was the least sensitive of the procedures examined. The commercial enzyme-linked immunosorbent assay system was the most practical method and offered the highest degree of sensitivity in detecting antibodies to cytomegalovirus.

Antibodies, Viral↗
PubMed1983

Multicenter clinical evaluation of long-term efficacy and safety of labetalol in treatment of hypertension.

The long-term efficacy and safety of labetalol, an antihypertensive agent with combined beta- and alpha-blocking activity, were evaluated alone (number = 193) and in combination with a diuretic (number = 144) in an open-label multicenter trial of 337 hypertensive patients aged 21 to 75 years, including initially 205 (61 percent) men and 219 (65 percent) Caucasians. There were 219 (65 percent) mild, 85 (25 percent) moderate, and 33 (10 percent) severe hypertensive patients. Labetalol (100 to 1,200 mg twice a day) alone or in combination with a diuretic reduced the mean standing blood pressure by 13/11 and 25/16 mm Hg to 135/88 and 130/91 mm Hg, respectively (p less than 0.01), and supine blood pressure by 6/7 and 18/13 mm Hg to 141/86 and 138/90 mm Hg (p less than 0.01), respectively. Blood pressure reductions observed at one month were maintained after one year; 206 (62 percent) patients had 10 mm Hg or greater reductions and 184 (56 percent) patients were maintained at diastolic blood pressures less than 90 mm Hg. Most frequently reported drug-related side effects included fatigue (14 percent), dizziness (12 percent), nausea (11 percent), nasal stuffiness (8 percent), headache (4 percent), and male sexual dysfunction (14 percent). Side effects were generally of mild to moderate intensity and often transient. In addition, in 27 (8 percent) patients reversible asymptomatic transaminase elevations to greater than twice normal developed at some time during the study. In 13 (4 percent) patients these alterations resolved during continued labetalol therapy, but in five (2 percent) patients these marked elevations led to discontinuation of the drug. A total of 32 (9.5 percent) patients were terminated prematurely due to side effects (most commonly genitourinary or gastrointestinal) possibly attributable to the drug. These findings indicate that labetalol with or without a diuretic is a potentially effective, safe, and relatively well-tolerated long-term antihypertensive therapy.

Adult↗
PubMed1983

Congenital peritoneal mesothelioma.

Only three primary peritoneal mesotheliomas in children have been previously reported. We describe a 6-wk-old girl with a papillary peritoneal mesothelioma of low grade malignancy. This is probably a congenital mesothelioma and is the youngest patient reported to date.

Female↗
PubMed1982

Light and electron microscopy of liver in hyperlipoproteinemic patients under long-term gemfibrozil treatment.

The effects of long-term gemfibrozil (Lopid) therapy on human liver structure are not known. Studies of this nature are becoming essential in determining the risk/benefit ratio since gemfibrozil is an effective agent for the control of hyperlipoproteinemia types IIa, IIb, and IV. Particularly, gemfibrozil is effective when dietary management or available therapeutic control fail to reduce serum cholesterol and triglycerides as well as normalizing the lipoprotein pattern. Percutaneous liver biopsies of 9 patients on long-term gemfibrozil therapy were evaluated by light microscopy, interference contrast optics and transmission electron microscopy. The distribution of patients according to lipoprotein phenotype was 3 Type IIa, 3 Type IIb, and 3 Type IV. Their lipoprotein patterns approached normal and the serum lipids were controlled during gemfibrozil therapy. By light microscopy, the lobular architecture and other parameters were within normal limits. Varying degrees of fatty change were found as would be expected. No preferential lobular disposition of the fat globules was evident. Coalescence of fat droplets, nuclear displacement and fatty cysts were noted. Differential interference contrast microscopy revealed several degrees of contrast amplitude in these droplets suggesting a heterogeneous lipid deposition in hepatocytes. The subcellular analysis revealed a moderate degree of glycogen deposition, absence of nuclear abnormalities and unremarkable mitochondria; the rough endoplasmic reticulum was not significantly altered and smooth surfaced membranes appeared proliferated. Detailed analysis of the peroxisome population showed matrix rarefaction, marginal plate formation and spurious densities though no significant proliferation occurred. Distribution of peroxisomes in hepatocytes varied widely from cell to cell and in different lobular areas. This study confirmed the association of hepatic fatty change with hyperlipoproteinemia irrespective of the pattern observed in circulating lipoproteins. Peroxisome proliferation, as seen in rodents when receiving gemfibrozil, did not occur and the structure of these subcellular organelles was not compromised. It was concluded that the long-term administration of this compound did not show adverse effects on the hepatocyte in hyperlipoproteinemia.

Gemfibrozil↗
PubMed1982

Budd--Chiari syndrome in a child.

We describe a 14-month-old female who presented with hepatomegaly 1 month after abdominal trauma. Eight years later, radiographic and histologic studies confirmed the diagnosis of Budd--Chiari syndrome with evolution to cirrhosis.

Abdominal Injuries↗
PubMed1982

Long-term use of gemfibrozil (Lopid) in the treatment of dyslipidemia.

This report describes the results of long-term treatment for blood lipid regulation with a new drug, gemfibrozil (Lopid). During a short-term placebo-controlled phase, gemfibrozil had significantly reduced triglycerides, VLDL-cholesterol and the LDL-cholesterol and had significantly increased HDL-cholesterol and the HDL-cholesterol to total cholesterol ratio. It had not, however, greatly affected total cholesterol and LDL-cholesterol. In the long term phase of the study the improvement attained during the controlled phase was maintained. More important, the lipoprotein values that had not shown improvement in the controlled phase showed definite beneficial changes. The types and incidence of adverse reactions during the long term treatment were similar to those observed during the controlled period. The results of the study indicate that gemfibrozil is effective and relatively safe for the long term treatment of lipid irregularities.

Adult↗
PubMed1982

Giant verruca vulgaris presenting as a neurotrophic foot ulcer.

The most common factor associated with neurotrophic ulcers is either a peripheral or central somesthetic deficit, such as may occur in peripheral neuropathies, myelodysplasia, syringomyelia, sciatic nerve injury, spinal cord injury, tabes dorsalis, and most commonly, in the peripheral neuropathy of diabetes. Distribution of the ulcers indicates a mechanical factor in development. Here, three patients with an unusual type of neurotrophic ulcer, giant neurotrophic verruca vulgaris, are presented.

Adult↗