Reaching RNs through the electronic classroom.
Explore the source record for details and available documents.
California↗
Biomedical subjects
J M Lewis
Publications and source records attributed to J M Lewis.
Multiple retinal occlusions from a left atrial myxoma.
Explore the source record for details and available documents.
Atrial Function, Left↗
First branchial cleft cysts presenting as parotid tumors.
Masses of the parotid gland region can be caused by a variety of different conditions, most commonly neoplasms of a benign or malignant nature. A rare cause for parotid tumors is the embryonologic remnant of first branchial cleft cysts. We reviewed branchial cysts for a 10-year period at the three teaching hospitals in Akron, OH. First branchial cleft cysts, or parotid lympho-epithelial cysts, were found to be a very rare condition presenting as parotid tumors. The surgeon should always be aware of these cysts as a possibility in the differential diagnosis of parotid masses in the infant and adult.
Aged↗
Superantigenic staphylococcal exotoxins induce T-cell proliferation in the presence of Langerhans cells or class II-bearing keratinocytes and stimulate keratinocytes to produce T-cell-activating cytokines.
Several staphylococcal toxins are among a growing number of immunostimulatory molecules called "superantigens" because of their ability, when presented by appropriate major histocompatibility complex class II+ accessory cells, to activate essentially all T cells bearing particular T-cell receptor V beta gene segments. We have examined the ability of murine epidermal Langerhans cells and/or keratinocytes to act as accessory cells in the T-cell response to the superantigens staphylococcal enterotoxin B and exfoliative toxin, also known as epidermolysin. Purified murine splenic T cells were stimulated with staphylococcal enterotoxin B or exfoliative toxin in the presence of Langerhans cells--enriched epidermal cells from normal mice or epidermal cells isolated from mice pretreated with recombinant interferon-gamma, a procedure that induces the expression of major histocompatibility complex class II molecules on keratinocytes. The data show that both Langerhans cells and class II-bearing keratinocytes can act as accessory cells in the T-cell response to staphylococcal enterotoxin B and exfoliative toxin. We also observed that both human and murine keratinocytes cultured in the presence of staphylococcal enterotoxin B or exfoliative toxin produce increased amounts of cytokine(s) capable of stimulating thymocytes and D10 cells, and that this toxin activity is independent of the level of expression of class II on keratinocytes. Studies by enzyme-linked immunosorbent assay showed that staphylococcal enterotoxin B stimulates keratinocytes to produce tumor necrosis factor-alpha but not interleukin-1, suggesting tumor necrosis factor-alpha and perhaps other cytokines are responsible for the T-cell proliferative activity. These results demonstrate that two distinct epidermal constituents (i.e. Langerhans cells and keratinocytes) can serve as accessory cells in the responses of T cells to superantigenic bacterial toxins. It is possible that such toxins contribute to the pathogenesis of a variety of skin diseases by either locally activating T cells bearing particular V beta genes and/or enhancing keratinocyte production of immunomodulatory cytokines.
Animals↗
The validity of the CPITN scoring and presentation method for measuring periodontal conditions.
The CPITN is used widely in estimating periodontal treatment needs and, in many cases also to make generalizations about periodontal disease. It is therefore imperative that the hierarchical scoring method used to allocate CPITN scores is validated, and that the presentation of CPITN data reflect the true distribution of periodontal conditions. Data from one study carried out in Melbourne, Australia and one in Jakarta, Indonesia were used to compare CPITN scores on a mouth, sextant and tooth basis. Clinical periodontal components were compared with CPITN scores to establish the validity of the CPITN hierarchical scoring method. The distributions of CPITN scores varied widely on a mouth, sextant and tooth basis, and CPITN scores frequently differed from those indicated by the periodontal components. It was concluded that CPITN data should be presented not only as the % of subjects with each score, but also as the % of sextants, and, if possible, the % of tooth sites with each CPITN score. It was also concluded that there is an advantage in measuring components (calculus and bleeding) as well as CPITN in order to limit the overestimation of treatment needs, particularly for anterior teeth.
Adolescent↗
Changes in periodontal conditions of adults from Melbourne, Australia.
Considerable information exists on the changing pattern of dental caries over the last two decades, however, little longitudinal information exists on changes in the pattern of periodontal diseases. This study measured the prevalence and severity of periodontal conditions in a sample of adults from Melbourne, Australia. Data were recorded by a small team of calibrated examiners for 200 subjects who were examined in 1985, re-examined in 1990, then successfully matched. The prevalence and severity of periodontal conditions decreased in subjects over the five-year study period. Over all sites, bleeding decreased from 51.2 per cent of sites examined in 1985 to 41.9 per cent of sites examined in 1990. The proportion of sites with attachment loss of 6 mm or more, decreased from 6.9 per cent to 3.2 per cent over the five-year period. In 1985, 25.6 per cent of sites had a CPITN score of 0, in 1990, 39.8 per cent of subjects presented with the same score. Notwithstanding the limitations of the measurement parameters used in the study, on average, the adult periodontal health of the sample suggested a trend to improvement over the five-year period.
Adolescent↗
The lives of female physicians.
Survey data from 113 female physicians, 634 male physicians, and 41 female dentists were compared. Instruments designed to assess work satisfaction, work stress, marital satisfaction, family competence, and psychiatric symptoms and treatment were used, thereby exploring important life domains concurrently. The results suggest that female physicians are much more like both male physicians and female dentists than anticipated. Generally, female physicians describe high levels of work satisfaction, moderate levels of work stress, average-to-high levels of marital satisfaction, and relatively low levels of psychiatric distress. Their lower levels of practice income remain something of an enigma as gender remains the most powerful predictor of income and is not replaced in statistical analyses by specialty, hours worked, or other significant variables. Finally, female physicians who find higher levels of satisfaction in work also report higher levels of marital satisfaction and fewer psychiatric symptoms. For these women, a highly satisfying medical career does not apparently need to be experienced at the cost of marital or personal distress.
Adult↗
A critical review of methods for the economic evaluation of fissure sealants.
Economic evaluation provides a method of systematically comparing the costs and outcomes of alternative health care programmes. It is being used increasingly to provide planning information. However, a review of the literature on economic evaluation of fissure sealants revealed a number of problems within studies. These included; the incorrect use of terms in labelling analyses, the choice of comparative procedures influencing the conclusions and equating different outcomes without regard for their disparate utilities. In addition, many studies did not report adjustment for differential timing of costs and consequences, or the use of incremental or sensitivity analyses. Future economic evaluations need to address these problems, in order that veracious information is supplied to decision-makers.
Cost-Benefit Analysis↗
Jonathan Swift and Alzheimer's disease.
Explore the source record for details and available documents.
Alzheimer Disease↗
Ring chromosome 12 resulting from nonrandom telomeric associations with the short arm of chromosome 15 in a cerebellar astrocytoma.
Ring chromosome 12 was found in an untreated cerebellar astrocytoma apparently resulting from nonrandom telomeric associations involving the short arm of chromosome 15, and both the long and short arms of chromosome 12. The clonal nonrandom telomeric associations of 15p to both ends of the chromosome 12 were transitory, but appear to be the precursor lesion in the evolution to ring chromosome 12 in this tumor. A multistep process in the formation of a ring chromosome resulting from nonrandom telomeric associations to both telomeres is illustrated.
Astrocytoma↗
Childhood play in normality, pathology, and therapy.
Links are sought between concepts of play pertaining to normal development, pathology, and therapeutic interventions. To this end, the components and functions of play are delineated, the evolution of the concept of play is reviewed, an integrated course for its development is advanced, and a framework and guidelines for its assessment in the clinical context are offered. Issues concerning the role of play in therapy are discussed.
Adolescent↗
Marital satisfaction in the lives of physicians.
Marital satisfaction data from a large sample of physicians and their spouses and dentists and their spouses suggest that about 85% of professionals and spouses are satisfied with their marriages. High levels of marital satisfaction are associated with high work satisfaction, low work stress, and fewer psychiatric symptoms. These findings do not support the widely held belief that physicians' marriages are more apt to be dysfunctional than those of other persons. The authors discuss this difference from two perspectives: (1) sampling differences and (2) differences between marital assessments from inside and outside the marriage.
Adult↗
Work satisfaction in the lives of physicians.
In a climate that many practitioners find increasingly oppressive, data suggesting the most and least satisfying aspects of medical practice are important. In a joint effort, the Dallas County Medical Society, Timberlawn Psychiatric Hospital, and Timberlawn Psychiatric Research Foundation explored levels of work satisfaction for their relationships with marital satisfaction and psychiatric symptoms as reported by physicians and dentists and their spouses. Most physicians and dentists rate various aspects of direct patient care and service to humanity as highly satisfying aspects of professional life. Physicians highly satisfied with their work are more likely to report high satisfaction in their marriages and fewer psychiatric symptoms. Most spouses of physicians report high levels of marital satisfaction, and high agreement exists between the marital satisfaction ratings of physicians and their spouses. Physicians and dentists are quite similar on the wide range of professional and personal variables surveyed.
Data Collection↗
Work stress in the lives of physicians.
The work stress of physicians is considered high, and many are contemplating leaving the profession. Documenting the specific aspects of practice found to be most stressful is important, and useful insights may be obtained by contrasting physicians who report high and low levels of work stress. Contrasting the work stress of physicians and dentists can be useful for both professions. Accordingly, we surveyed 3156 members of the Dallas County Medical Society and 1273 members of the Dallas County Dental Society plus a large group of their spouses. Although the level of work satisfaction is the most powerful predictor of work stress, other significant predictors are younger age, long working hours, and solo practice. Physicians who report high levels of work stress also report lower levels of marital satisfaction and a higher prevalence of psychiatric symptoms. Dentists are much like physicians in their reports of overall work stress, and the similarities and differences regarding specific stressors suggest the two professions are more alike than different in reporting the stresses of professional practice.
Data Collection↗
A novel reciprocal chromosome translocation t(11;22)(p13;q12) in an intraabdominal desmoplastic small round-cell tumor.
We report an intraabdominal desmoplastic small round-cell tumor that contains a novel reciprocal chromosome translocation t(11;22)(p13;q12). The tumor showed a reciprocal chromosome translocation which is different from the (11;22)(q24;q12) translocations seen in Ewing's and other small-cell tumors but affects the same break-point on chromosome 22(q12). This reciprocal chromosome translocation may prove to be a marker for intraabdominal desmoplastic small round-cell tumors.
Abdominal Neoplasms↗
Vitamin A and Alzheimer's disease.
Explore the source record for details and available documents.
Alzheimer Disease↗
Multifocal epithelioid hemangioendothelioma in bone.
The case of a 17-year-old male with multifocal, grade I epithelioid hemangioendothelioma of the right ankle and foot is presented. The major symptom was poorly localized ankle pain refractory to conservative management. Imaging studies, including roentgenograms, computed tomographic scan, and magnetic resonance imaging, revealed multiple lesions in the right distal tibia, talus, calcaneus, and first cuneiform. An open biopsy of the right talus confirmed the diagnosis, and treatment consisted of localized radiation therapy to the affected area. We review the literature of this rare neoplasm from the initial descriptions to current nomenclatures and conceptualizations of the tumor.
Adolescent↗
Thirty years of teaching psychotherapy skills.
The author outlines a basic model for teaching psychotherapeutic skills that includes five modules relating to (1) the dynamics of exploration, designed to encourage the patient's affective expression; (2) relationship structure, considering patterns of patient-therapist interaction along a closeness/separateness continuum; (3) affect, empathy, and distance regulation, emphasizing the crucial significance of identifying correctly and responding empathically to patients' affective messages; (4) basic cognitive interventions, focused on techniques for facilitating the patient's narrative flow and capacity to analyze experiences, and for formulating the patient's psychopathology; and (5) the therapist's use of self. The author concludes by examining why systematic psychotherapy training is particularly important at this time, in light of such pressures as managed health care, neuroscientific advances and psychopharmacologic breakthroughs, and the wave of self-help organizations.
Affect↗