Biomedical subjects
Publications and source records attributed to J E Lewis.
A 27-year-old black man with Crohn's disease and nodules on the legs is described. Such nodules constitute one of three types of cutaneous manifestations which have a histological picture of a non-caseating granuloma. The two other varieties of skin lesions described are: that resulting from a direct spread from the gastrointestinal tract, and that resulting from spread over contiguous skin.
Congenital Bochdalek hernias result in significant mortality in the newborn period. Forty-four cases over a nineteen year period are presented. The overall mortality is 34 per cent; however, it has decreased from 41 to 25 per cent in the last five years. The mortality of those patients less than 24 hours old remains high (33 per cent) but improved. We prefer the abdominal approach and believe that prolonged respiratory support will salvage a significant number of these critically ill infants.
The case of a patient with a recurrent, painful ulceration on the lower leg, clinically and histologically resembling hidradenitis suppurativa, is presented. The fact that this site is devoid of apocrine glands supports the concept that apocrine involvement in hidradenitis suppurativa is coincidental and that these glands are involved secondarily. It is suggested that in this patient the pathogenesis of the disease is follicular occlusion rather than selective apocrine poral closure.
Untreated craniofacial fractures may result in a deformity similar to that which results from underdevelopment of the maxilla. Such a deformity can be corrected by osteotomy simulating Le Fort type III fracture lines. This operation necessitates careful pre-operative planning which incorporates a feasibility study with the combined use of dental study casts, cephalometric radiography and life-size photographic reproductions. A case history which describes the management of late complications of a malunited class III fracture is given.
A rapid, sensitive, and specific radioimmunoassay has been developed for the measurement of amikacin, a new semisynthetic aminoglycoside antibiotic. Antisera were produced by immunizing rabbits with amikacin conjugated to porcine thyroglobulin. Sera were screened for amikacin antibodies with (3)H-labeled amikacin. Free and bound radioactivity were separated by the second antibody method. As little as 5 ng of the antibiotic can be measured in serum, cerebrospinal fluid, and urine. The standard curve is unaffected by pH (5-11), ionic strength (0.01 M to 0.3 M), MgCl(2) or CaCl(2) (1 to 8 mM/liter), or urea (10-300 mg/100 ml). The antibodies raised to amikacin are not able to distinguish between kanamycin and amikacin. The cross reactivity of all other antibiotics tested was <0.1%. Co-incubation of first and second antibody allows for a 30-min incubation period, making the assay useful for stat determinations. The standard curve is linear on a logit-log plot, allowing for rapid computer analysis of the standard curve, interpolation of sample values, and quality-control monitoring.
Serum diiodotyrosine (DIT) was measured by radioimmunoassay in healthy subjects patients with thyroid disease and a variety of laboratorty animals. Ninety-two healthy adults had a mean level of 101 ng/100 ml. There was no sex difference in DIT levels but DIT fell with aging. There was no change with short term oral SSKI administration. Athyrotic subjects had measurable but reduced levels (mean = 52 ng/100 ml). Hyperthyroid subjects had levels slightly, but not significantly, higher than controls (mean = 149 ng/100 ml). Treatment of hyperthyroidism was followed by a small but significant fall in DIT levels, but there was no change in DIT levels with thyroid hormone therapy of hypothyroidism. A large species variation in serum DIT levels was found among laboratory animals with mean levels ranging from 17 ng/100 ml in mice to 428 ng/100 ml in dogs.
A prospective study of 208 patients treated for up to 12 months with isoniazid (INH((R))) for tuberculosis prophylaxis was made. Levels of serum glutamic oxaloacetic acid transaminase (SGOT) became elevated in 20 percent of the adults followed and in 30 percent predominantly nonspecific symptoms developed, in 11 percent simultaneously with SGOT elevation; SGOT levels became elevated in two of 33 children and 1 was symptomatic. Mild SGOT elevations in asymptomatic adults were self-limited; however, a small percentage of symptomatic adults showed prolonged SGOT elevation for months after INH was completed. Results of liver biopsy studies in the early stages of SGOT elevation generally showed portal and periportal lymphocytic infiltrations with lesser numbers of plasma cells, neutrophils and eosinophils.
A technique for the induction of sensitization in pigs with a nickel-alanine conjugate has been reported by other investigators. Similar results were observed in our experiments in mini-pigs. However, using the identical technique, we were unable to induce sensitization in guinea pigs with NiSO4, with nickel-alanine or other nickel-amino acid complexes, or with a complex of nickel with soluble guinea pig skin extract. These results indicate that nickel-amino acid complexes and nickel-guinea pig skin complex were not antigenic in guinea pigs with this technique. Hypotheses for the apparent failure to induce sensitization are proposed.
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A radioimmunoassay has been developed for the measurement of 3,5-diiodo-L-tyrosine (DIT) in serum. DIT was coupled to porcine thyroglobulin (PTg) with a molar ratio of 205:1. Rabbits were immunized with 1 mg of immunogen emulsified in complete Freund's adjuvant. Sera were screened for their ability to bind trace amounts of [125I]DIT. A serum that bound 40% of the tracer at a final dilution of 1:1,750 was used in the assay. Assay specificity was improved by the use of thyroxine (T4)-binding globulin as a second ligand-binding protein to decrease T4 and triiodothyronine (T3) cross-reactivity with the antibody. Double antibody and polyethylene glycol radioimmunoassays were compared. DIT present in the second antiserum shifted the double antibody assay standard curve and altered estimates of assay specificity and assay sensitivity. By using the polyethylene glycol system and butanol:ethanol extracts of serum, DIT was measured in human serum. In 35 apparently healthy young adult controls DIT levels averaged 156 ng/100 ml. Random DIT levels averaged 158 ng/100 ml in 11 untreated hyperthyroid patients and 84 ng/100 ml in 15 untreated primary hypothyroid patients. No diurnal pattern in DIT levels could be demonstrated. Thyroid-stimulating hormone administration led to a variable but small rise in DIT levels, but short term T3 suppression was not associated with a measurable fall in DIT concentrations. Paired serum samples from the carotid artery and thyroid vein of 10 euthyroid goiter patients and one patient with a toxic solitary adenoma all showed a positive transthyroidal gradient indicating the thyroidal release of DIT in each patient. Measurable DIT levels of 45, 47, 68, and 80 ng/100 ml, respectively, were found in four fasting athyrotic patients indicating that the thyroid is not the only source of serum DIT.
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