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Biomedical subjects

J E Lewis

Publications and source records attributed to J E Lewis.

At least 145 records · Page 8Linked to original sources
PubMed1981

Challenges in the care of the retarded child with Duchenne muscular dystrophy.

Recent psychological testing and neuropathologic studies support the occurrence of relative retardation, an in some cases severe retardation, in patients with Duchenne muscular dystrophy. Muscle deterioration and wasting are associated with the natural progression of the disease. Progressive physical weakness can be described in the following stages: early, walking, wheelchair, and late. The more emotionally mature the family, the more effective they are in coping at each stage of the disease. Nevertheless, a constant stress is present in all families. This stress can increase or plateau at the various stages and as new problems are encountered. When mental retardation is significant, the stress on the family become even more marked.

Ambulatory Care↗
PubMed1981

Sweet's syndrome. Report of a case.

A case of relentlessly recurrent, violently inflammatory, and extremely painful Sweet's syndrome of twenty-three years' duration is presented. For many years lesions were often solitary, and frequently localized to the left adductor thigh. This led to the misdiagnosis of the condition as recurrent herpes simplex. For twenty-three years the disease was localized to the left lower extremity. Recurrences became more protracted during the past two years. The most prominent symptom was lesional pain, and recently this could not be relieved with narcotic analgesics. Lesions were asymmetric, bright red, raised, painful and had sharp borders. The largest lesion measured 18 cm in diameter. Response to systemic steroids was prompt and dramatic, and healing occurred without scarring.

Adult↗
PubMed1980

Nesidioblastosis in children.

Three cases in which seizure disorder was first noticed were examined in the last seven years; low fasting glucose and high serum insulin levels then led to the diagnosis of severe hypoglycemia secondary to nesidioblastosis. Hypoglycemic episodes were uncontrolled by frequent oral feedings and intravenous administration of dextrose, glucagon, and diazoxide. Within three weeks after diagnosis, all three patients underwent subtotal pancreatectomy; all three survived and have been followed-up for two to seven years. Two remain euglycemic and have no evidence of CNS damage. The third has occasional fasting hypoglycemia that is treated with diazoxide; he continues to have a seizure disorder and is mentally retarded. Neonatal hypoglycemia secondary to hyperinsulinism requires prompt recognition and aggressive treatment to avoid irreversible CNS damage. Subtotal pancreatectomy safely and effectively restores the euglycemic state.

Adenoma, Islet Cell↗
PubMed1980

Modified lingual split technique for extraction of impacted mandibular third molars.

Critical evaluation of existing chisel and bur techniques for removal of impacted mandibular third molars reveals a high incidence of complications. Both approaches require creation of a buccal defect immediately distal to the second molar for the insertion of an elevator, which may cause pocketing to occur postoperatively. The method described here minimizes periosteal reflection, almost completely avoids loss of bone, and effectively reduces the use of rotary instrumentation. The planning of the soft tissue flaps and bony cuts assists in primary wound closure, obliteration of dead space, and reduction of postoperative morbidity.

Alveolectomy↗
PubMed1980

Surgical treatment of recurrent herpes simplex.

A case of recurrent herpes simplex that triggered recurrent severe erythema multiforme is presented herein. Erythema multiforme was controlled by high doses of prednisone. Epidermal excision of early recurrent attacks of erythema multiforme, thus avoiding the necessity of systemic steroids. A total of eighteen crops of recurrent herpes lesions have been removed to date. The treatment approach has been very acceptable to the patient.

Erythema Multiforme↗
PubMed1979

Epidemic of mumps in a partially immune population.

The incidence of mumps in vaccinated and nonvaccinated schoolchildren was studied after a recent epidemic. Information was collected by telephone interviews with the parents and a review of the physicians' records. The vaccine appeared to be effective, for the incidence of mumps in the 145 vaccinated children--5.5%, or 8 cases--was significantly less (P less than 0.001) than the incidence in the 350 children considered susceptible to infection--21.7%, or 76 cases. The percentage of children who had been immunized decreased with increasing age, and acquisition of immunity through natural infection had the reverse trend; thus, the proportions of children susceptible to infection in each age group were about the same, and the age-specific attack rates were similar. Although the mothers were accurate in indicating absence of vaccination, they incorrectly indicated vaccination of their children 43.0% of the time; this error in reporting could influence vaccine administration in older children. Our findings suggest that mumps vaccination may substitute for natural illness in immunizing populations, and that more extensive use of the vaccine over a broader age range is required to prevent similar epidemics in the future.

Adolescent↗
PubMed1979

Esophageal atresia and tracheoesophageal fistula: preoperative assessment and reduced mortality.

One hundred twenty-nine infants with esophageal atresia and tracheoesophageal fistula were reviewed from 1955 to 1978. The overall mortality was 38%. Factors associated with the increased mortality include prematurity, pneumonia, and congenital defects other than this anomaly. A classification based on these factors in introduced, which provides the clinician with a prognostic survival rate greater than 90% with only physical examination, chest and abdominal roentgenography, and intravenous pyelography. Postoperative mortality was reduced to 11% in the last five years of the study; this is attributed to the exclusive use of the retropleural approach to the esophagus, more intensive postoperative ventilatory support, and routine use of parenteral nutrition.

Esophageal Atresia↗
PubMed1978

Purulent pericarditis in children.

Acute purulent pericarditis was treated successfully in five children between the ages of 27 months and 11 1/2 years during the past 5 years. The responsible organism was Hemophilus influenzae, type b, in two cases and Meningococcus, Pneumococcus, and coagulase-positive Staphylococcus aureus in one case each. No primary source of infection could be identified in two patients. A high index of suspicion, combined with immediate echocardiograms and pericardiocentesis, led to the diagnosis. Immediate antibiotic therapy was instituted on the basis of the gram stain of the pericardial fluid. All five patients had a pericardial window established--four through subxyphoid approach and the fifth, because of a left pleural effusion, through a left thoracotomy. When the subxyphoid approach was used, sump drains were left for postoperative suction and irrigation. All five patients survived without sequalae during follow-up periods of from 18 months to 5 years. We advocate an aggressive approach to the diagnosis and treatment of this problem. This report documents the safety, ease, and effectiveness of the subxyphoid approach as a means of drainage.

Child↗
PubMed1978

Measurement of three aminoglycosiee antibiotics with a single radioimmunoassay system.

A versatile radioimmunoassay procedure has been developed to specifically assay gentamicin, tobramycin, or amikacin. Iodinated derivatives of these three antibiotics were prepared by a modified Bolton and Hunter procedure. A single reagent system composed of a pool of three very specific antisera was used in the procedure. The antisera combination did not alter the specificity of the procedure. Validation of the assay of the three antibiotics included studies of parallelism, accuracy, precision, reproducibility, and method comparison with other radioimmunoassay procedures involving single antiserum systems. We discuss the application of this multiple assay capability to other procedures involving use of immunochemicals.

Amikacin↗
PubMed1977

Le Fort III osteotomy in Crouzon's disease.

The features of Crouzon's disease are craniostenosis and maxillary hypoplasia. A patient with Crouzon's disease is presented, on whom Le Fort III osteotomy and osteotomy of the mandible were performed, involving the insertion of 9 bone grafts to maintain the correction and to improve the facial appearance.

Adult↗
PubMed1977

Antibodies against human lymphokines: I. Methods for induction of antibodies capable of neutralizing stable (alpha) and unstable (beta) lymphotoxins released in vitro by activated human lymphocytes.

Various methods were employed to induce antibodies in rabbits that were capable of neutralizing different families of lymphotoxins (LT). Both stable (alpha-LT) and unstable (beta-LT) molecules, released by activated human lymphocytes in vitro, were neutralized. The different LT families were first separated into their respective groups by physical-chemical methods. Immunization with small quantities of antigen yielded a high percentage of responder animals. Techniques were developed for eliciting alpha-LT antibodies using as little as 2--3 ml of a cell-free supernatant. The situation was more difficult, however, when the unstable beta-LT molecules were employed as antigens. We found that because of the low concentration and lability of beta-LT in supernatants, the immunizing dose had to be: a) handled rapidly, b) larger than that used with the alpha-LT, and c) injected at closer intervals and over a longer immunization protocol. Physical-chemical studies supperted the concept that the LT-neutralizing activity in the immune serum was immunoglobulin.

Animals↗
PubMed1977

Effective treatment of infantile myasthenia gravis by combined prednisone and thymectomy.

Myasthenia gravis developed in two children at 2 and 3 years of age respectively. Minimal improvement followed chronic oral administration of cholinesterase inhibitors. Patient 1 had ptosis and ophthalmoplegia but no clinical or electromyographic involvement of muscles of the extremities, although a quadriceps muscle biopsy revealed lymphorrhages. Patient 2 had progressive generalized myasthenia for 3 1/2 years. Both children were given a 3-month course of prednisone followed by thymectomy. They both are in remission, 12 and 8 months after thymectomy, with only minimal residual ocular weakness, but this weakness is much more responsive to anticholinesterase drugs than before thymectomy. Long-term administration of steroids, with the attendant complication of growth retardation, is avoided.

Age Factors↗