Biomedical subjects
S W Lewis
Publications and source records attributed to S W Lewis.
Obstetric complications, neurodevelopmental deviance, and risk of schizophrenia.
It is concluded from a review of the literature and a pilot survey that schizophrenic patients more frequently have a history of obstetric complications (OCs) than do other psychiatric patients and normal subjects. OCs are associated with increased cerebral ventricular size in both infancy and adulthood, and are more common among non-familial schizophrenic patients. Neonatal cerebrovascular events consequent upon OCs provide a mechanism to explain the increased risk of neurodevelopmental deviance and later schizophrenia.
Family history and birthweight in monozygotic twins concordant and discordant for psychosis.
In a sample of monozygotic twins, intrapair differences in reported birthweight were larger in those pairs discordant for later psychosis, compared to pairs concordant for psychosis. A trend towards less family history of psychiatric disorder was also found in the discordant pairs.
Brain imaging in a case of Capgras' syndrome.
A patient developed Capgras' syndrome as part of an interictal psychosis of epilepsy; magnetic resonance imaging revealed bilateral subcortical lesions in occipitotemporal and frontal regions. These findings have implications for the postulated association between Capgras' syndrome and neuropsychological deficits, in particular prosopagnosia.
The familial/sporadic distinction as a strategy in schizophrenia research.
The rationale and limitations of discriminating between cases of schizophrenia with and without a family history are reviewed. It is concluded from the evidence available that, by identifying subgroups of greater aetiological homogeneity, the strategy can be a useful starting point for research into likely causes.
Lateral ventricular size in schizophrenia.
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Towards an aetiological classification of schizophrenia.
The genetic contribution to schizophrenia is widely accepted, yet none of the proposed models of transmission has been convincing. Schizophrenia is generally viewed as aetiologically homogeneous with the exception of supposedly rare "phenocopies" associated with organic brain lesions and without a family history. However, up to one-third of schizophrenics have enlarged cerebral ventricles, and this appears to be a consequence of environmental damage. Although the aetiology of schizophrenia comprises genetic and environmental components acting in variable proportions, a simple division into familial and sporadic cases would facilitate research. Families with several ill members will be most valuable for molecular genetic studies, while the new brain imaging techniques should be particularly directed towards sporadic cases.
Management of the asymptomatic patient with an abnormal exercise electrocardiogram.
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Clinical correlates of septum pellucidum cavities: an unusual association with psychosis.
Cavities in the septum pellucidum are widely regarded as incidental findings of little clinical importance. The prevalence of such cava on computerized tomography in a mixed sample of 22000 neurological and psychiatric patients is found to be 0.15%. A statistical association between this anomaly and a referral diagnosis of functional psychosis is reported, and 6 cases are described. These cases were male and characterized by an early history of developmental delay, with lifelong disturbances of emotion and behaviour prior to the onset in early adulthood of an atypical schizophrenia-like psychosis with disorders of speech and movement. It is suggested that septal cavities may signal an underlying abnormality of function relevant to the pathogenesis of these illnesses.
The prognosis of patients with chronic obstructive pulmonary disease after hospitalization for acute respiratory failure.
We followed the course of 36 consecutive patients hospitalized with chronic obstructive pulmonary disease and acute respiratory failure due to exacerbation of chronic bronchitis in order to clarify the prognosis in this common group of patients. All of the patients had spirometric evidence of severe, poorly reversible airflow limitation and all had a similar cause of acute respiratory failure. In addition, all received similar treatment during hospitalization and follow-up. Patients wtih asthma and pneumonia were excluded by clinical, spirometric, and roentgenographic criteria. Hospital survival was 94 percent, and only one patient required intubation. Two-year survival was 72 percent, and none of the patients died during a readmission for acute respiratory failure. This prognosis is much better than commonly recognized and compares favorably to that of stable outpatients with similar degrees of airflow limitation. An episode of acute respiratory failure, triggered by an exacerbation of chronic bronchitis, does not necessarily alter the prognosis of patients with COPD.
Controlled clinical trial of methylprednisolone in patients with chronic bronchitis and acute respiratory insufficiency.
To evaluate the role of corticosteroids as treatment for acute exacerbations of chronic obstructive pulmonary disease, we conducted a double-blind, randomized, placebo-controlled trial in 44 consecutive patients with chronic bronchitis and severe airflow obstruction. All were hospitalized with acute respiratory insufficiency from acute bronchitis. Patients with asthma, atopy, or pneumonia were excluded. Treatment consisted of intravenous aminophylline, inhaled isoproterenol, antibiotics, and either methylprednisolone, 0.5 mg/kg of body weight, or placebo every 6 h intravenously for 72 h. Bedside spirometry was done before and after bronchodilator inhalation three times daily. The methylprednisolone-treated group had a greater improvement in both prebronchodilator and postbronchodilator forced expiratory volume in 1 second (P less than 0.001). More patients with large improvements in their prebronchodilator or postbronchodilator flow rates, or both (greater than or equal to 40% by 72 h), received methylprednisolone (P less than 0.01). Methylprednisolone improved airflow more than placebo when added to standard therapy in patients with chronic bronchitis and acute respiratory insufficiency.
Prolonged respiratory paralysis in wound botulism.
Two patients had wound botulism with longer duration of respiratory paralysis than previously described. Each sustained extensive trauma to soft tissues and grossly contaminated wounds when thrown from a vehicle in a rural area. Progressive muscular weakness and respiratory distress occurred 8 and 13 days after injury, in the presence of infected wounds and clinical and laboratory findings characteristic of botulism. Spontaneous vital capacity and inspiratory effort served as bedside indicators of ventilatory function throughout 11 weeks of ventilatory support in each case and paralleled other clinical assessments of progress and recovery. Wound botulism may result in neuromuscular paralysis for a prolonged period. These cases illustrate the primary role of scrupulous nursing and respiratory care throughout such a period of ventilatory insufficiency.
Flow injection assays with chemiluminescence and bioluminescence detection--a review.
This paper reviews publications that combine the technique of flow injection (FI) with chemiluminescence (CL) and bioluminescence (BL) detection, from the earliest papers in 1979/80 to mid-1992, and refers exclusively to reactions occurring in solution. Air-segmented systems and liquid chromatography with CL detection are not considered unless FI has been used to pre-optimize the system. The applications have been categorized in terms of the type of CL reaction; there are separate entries for luminol, peroxyoxalate, other CL reactions and BL reactions. Each of the four sections includes a table of applications that lists the analyte, the nature of the reaction, the sample matrix and the limit of detection.
Low birth weight and a family history of schizophrenia predict poor premorbid functioning in psychosis.
Risk factors thought to predispose to schizophrenia, and premorbid functioning, were assessed blind to diagnosis by interviewing the mothers of 73 patients with DSM-III schizophrenia or affective psychosis. Higher risk of schizophrenia in relatives, lower mean birth weight, a more frequent history of obstetric complications, and poorer educational achievement distinguished the patients with schizophrenia from those with affective psychosis. Low birth weight and obstetric complications each predicted childhood schizoid and schizotypal traits. Poor social adjustment between ages 5 and 11 was predicted by low birthweight and by a family history of schizophrenia.
Investigation into the temporal stability of aqueous standard solutions of psilocin and psilocybin using high performance liquid chromatography.
This paper reports an investigation into the temporal stability of aqueous solutions of psilocin and psilocybin reference drug standards over a period of fourteen days. This study was performed using high performance liquid chromatography utilising a (95:5% v/v) methanol: 10 mM ammonium formate, pH 3.5 mobile phase and absorption detection at 269 nm. It was found that the exclusion of light significantly prolonged the useful life of standards, with aqueous solutions of both psilocin and psilocybin being stable over a period of seven days.