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Biomedical subjects

J R Lewis

Publications and source records attributed to J R Lewis.

At least 55 records · Page 3Linked to original sources

Body contouring.

The prospect of surgical body contouring is a rather recent innovation for the surgeon. For underdeveloped or atrophic breasts, augmentation mammaplasty is reasonably successful. For ptosis and/or hypertrophy of the breast, reduction and elevation on the chest wall by making the breasts more conical and more projecting is a common procedure for the plastic surgeon. Breast reconstruction is now done after either simple or radical mastectomy, and subcutaneous mastectomy procedures, preserving the nipple and areola, are also commonly done for disease of the breast which is not yet malignant. The abdomen which has been stretched and distorted with scars and striae can be reconstructed by resecting excess skin and fat and tightening up the underlying musculature and fascia. Excess fullness in the lateral aspect of the hips or relaxation, wrinkling, and sagging of the skin of the thighs can be corrected by a thigh lift and surgery for lipodystrophy, keeping most of the scars high in the inguinal area and in the inferior gluteal crease. The buttocks themselves can be corrected if sagging or hypertrophic and, in the exceptional case, even an augmentation to the buttocks similar to that of the breasts can be done.

Abdomen↗

Use of a sliding flap from the abdomen to provide cover in breast reconstructions.

A method of breast reconstruction after mastectomy, using wide undermining of the chest and abdominal skin and advancement of the latter upward to create a pocket, is described. A double-lumen silicone prosthesis is inserted to create the mound, and various methods for nipple-areolar construction are described. The method has been in use for 20 years, and it has been quite satisfactory when the deficiency in the chest wall cover is not too large.

Breast↗

Surgical face lift.

The growing importance of the face lift and related procedures to improve the aging face and the increasing demand by both men and women for these procedures is largely due to the prolonged good health, active life, and extended working years of many people. The technic described emphasizes support of the facial tissues upward and backward, leaving the resulting scars in the least obvious locations. Illustrative cases show improvement in appearance by upper and lower blepharoplasty and by the temple, cheek, and neck lift. The importance of a "segmental approach" is mentioned and other accessory procedures which may contribute further to improvement of the aging face are described, including rhinoplasty, mentoplasty, surgical abrasion, and chemical peel.

Aging↗

Valproic acid (Depakene). A new anticonvulsant agent.

Valproic acid, a new anticonvulsant, is most effective in absence seizures (simple and complex), but it has produced improvement in tonicclonic seizures, mixed absence with tonic-clonic seizures, and myoclonic epilepsy. It is useful alone or as an adjunct to other anticonvulsants and may allow the dosage of the latter to be reduced. Some patients who are refractory to other anticonvulsants may respond to valproic acid. Adverse reactions occur in about 20% of patients. Gastrointestinal disturbances and drowsiness (usually noted when valproic acid is given with other anticonvulsants) are the most common reactions; hair loss is observed less frequently. Untoward effects are usually transient and do not require discontinuation of use of the drug.

Animals↗

Prinzmetal's angina, normal coronary arteries and pericarditis.

A woman with Prinzmetal's variant angina had spontaneous attacks of myocardial ischemia characterized by severe chest pain, hypotension, inferior ST-segment elevation, transient complete heart block and selective right ventricular dysfunction. Despite initial improvement following intravenous administration of atropine and sublingual administration of nitroglycerin she died of cardiogenic shock. Autopsy showed normal coronary arteries and acute pericarditis, more pronounced over the right side of the heart. It is postulated that the pericardial inflammation elicited severe spasm of the subjacent right coronary artery.

Aged↗

Echocardiography: pericardial tickening and constrictive pericarditis.

To evaluate the relation between mitral valve motion and left ventricular end-diastolic pressure, the PR-AC interval, an index derived from the electrocardiogram and mitral echogram, and the left ventricular endodiastolic pressure were determined simultaneously in 22 patients undergoing diagnostic cardiac catheterization. Intravenous infusion of dextran or administration of nitroglycerin was used to alter left ventricular end-diastolic pressure to determine if there was a predictive relation between this pressure and the PR-AC interval during acute hemodynamic manipulations. There was a weak negative correlation (r = -0.33, P less than 0.01) between this pressure and the PR-AC interval. At rest a PR-AC interval greater than 0.06 second correctly predicted a left ventricular end-diastolic pressure of less than 20 mm Hg in 15 of 16 subjects. However, in four of six subjects with a PR-AC interval of 0.06 second or less, the end-diastolic pressure was less than 20 mm Hg. After interventions that varied left ventricular end-diastolic pressure by a factor of 2, the PR-AC interval changed slightly or not at all. These data suggest that the PR-AC interval is of limited value in predicting abnormal values or serial changes in left ventricular end-diastolic pressure.

Adult↗

New antirheumatic agents: Fenoprofen calcium (Nalfon), naproxen (Naprosyn), and tolmetin sodium (Tolectin).

The new antirheumatic agents, fenoprofen calcium, naproxen, and tolmetin sodium, are effective in the management of rheumatoid arthritis. Their efficacy is comparable, but not superior, to that of aspirin in usual oral doses. These agents also may be useful in degenerative joint disease and ankylosing spondylitis and as analgesics and antipyretics; however, there are insufficient data available to establish their efficacy and dosages for these uses. The incidence of adverse reactions, including gastrointestinal bleeding, is lower with these agents than with aspirin; thus, these drugs may be useful substitutes in patients who cannot tolerate the gastrointestinal effects of aspirin.

Anti-Inflammatory Agents↗

Carcinoma arising in the area of median rhomboid glossitis.

Routine soft-tissue examination of a 44-year-old Negro woman who consulted her dentist for a new maxillary partial denture revealed a depressed white lesion in the area of median rhomboid glossitis. Biopsy diagnosis of the area was well-differentiated squamous-cell carcinoma. The relation of this lesion to median rhomboid glossitis is questioned in view of previous reports.

Adult↗

Correction of extensive neck contractures with local flaps and split- and full-thickness grafts.

A technic of combined split-thickness and full-thickness skin grafts and local flap closure for extensive deep cicatricial neck contractures is presented. The head and neck are mobilized by excision of limiting tissues. The lateral neck skin is mobilized to be rotated anteriorly as flaps, and a full-thickness skin graft is applied to the central neck. Split-thickness skin grafts are placed below the full-thickness graft and flaps, and also above the full-thickness graft over the horizontal part of the neck. The success of this technic relies upon the limited contracture of full-thickness skin grafts, mobilization of lateral neck tissue, and consideration of regional units of the neck. This relatively simple operation results in a dramatic and lasting improvement of the neckline, good range of motion of the head and neck, elimination of multiple operative procedures, and early rehabilitation of the patient.

Cicatrix↗

The reduction mammaplasty--a combined technique.

The purposes of the reduction mammaplasty are: (1) the relief of the pain and discomfort of heavy, pendulous breasts; (2) the reduction is size of the breasts to achieve a normal and pleasing result with the brassiere in place and with clothing; (3) a reasonable and pleasing contour of the breasts from front and side, without the support of clothing or brassiere; (4) normally sensitive nipples which become erect on stimulation; (5) minimal apparent permanent scarring; (6) ideally intact ducts to the nipple; (7) a breast of size allowing for examination for breast masses. It is understandable that certain circumstances may forestall the achievement of some of these objectives, such as the presence of considerable amounts of diseased breast tissue, scars from resections of lesions of the breasts or from trauma, and massive hypertrophy of the breasts which may dictate a technique requiring free transplantation of nipples and areolae. However, several of the recent techniques allow for the achievements of these goals in a large percentage of cases. A combination of the better aspects of the techniques, with minor variations, may serve to deal even better and more consistently with the problem.

Breast↗