Search PubMed⌕ Search

Biomedical subjects

V Lewis

Publications and source records attributed to V Lewis.

At least 19 recordsLinked to original sources
PubMed1999

Survey of genetic screening for oocyte donors.

OBJECTIVE: To describe current screening practices of oocyte donation programs in the Society for Assisted Reproductive Technologies (SART). DESIGN: Descriptive data from a mailed questionnaire. SETTING: Academic medical center. PARTICIPANT(S): In vitro fertilization programs in SART. INTERVENTION(S): Survey mailed to IVF programs in the SART registry. MAIN OUTCOME MEASURE(S): Current practices, opinions, and genetic criteria for oocyte donor selection. RESULT(S): Results from 159 of 229 (69%) eligible oocyte donation programs are described. Most centers (70%) completed fewer than 25 cycles and used both anonymous and directed donors. There was considerable variability in limits on numbers of cycles or births allowed per donor, with many centers having no limits. As well, the use of well-established screening tests for genetic disorders, such as sickle cell anemia and cystic fibrosis, varied considerably. Consultation with a geneticist was possible at most (89%) centers and specifically mentioned by some centers as a means to help make decisions. CONCLUSION(S): Most programs follow recommendations made by the American Society of Reproductive Medicine (ASRM) for screening of gamete donors, but a significant percentage does not use well-established testing. The widespread availability of genetic consultation should promote responsible screening practices.

Female↗
PubMed1998

Nutrient intake and growth of infants with phenylketonuria undergoing therapy.

BACKGROUND: Because of reports of poor growth, a study was conducted for 6 months in 35 infants with classic phenylketonuria diagnosed during the neonatal period who were fed Phenex-1 Amino Acid Modified Medical Food With Iron (Ross Products Division, Columbus, OH, U.S.A.).as their primary protein source. METHODS: Diet diaries and anthropometric measures were obtained monthly as part of a larger study in which nutrition status was evaluated. RESULTS: In 6-month-old infants, mean percentiles for crown-heel length (59.14+/-4.31 SEM), head circumference (63.88+/-4.50) and weight (71.51+/-4.25) were normal. Mean (+/- SEM) daily intake of medical food was 79+/-4 g; protein and energy intakes were 17.3+/-0.6 g and 2772+/-75.6 kJ (660+/-18 kcal). Mean daily phenylalanine and tyrosine intakes per kilogram of body weight were 40+/-1 mg and 219+/-9 mg. Intakes of protein, energy, and tyrosine were positively correlated with crown-heel length, head circumference, and weight at 3 months of study. Overall plasma phenylalanine and tyrosine concentrations during the 6-month study were 297+/-41 micromol/l and 58+/-5 micromol/l, respectively. Neither plasma phenylalanine nor tyrosine concentration was correlated with growth. CONCLUSION: Phenex-1 supports normal growth when fed in adequate amounts. These data support those of the Medical Research Council Working Party on Phenylketonuria for 3 g/kg per day of amino acids from medical food.

Body Height↗
PubMed1998

Familiar face and voice matching and recognition in children with autism.

Relatively able children with autism were compared with age- and language-matched controls on assessments of (1) familiar voice-face identity matching, (2) familiar face recognition, and (3) familiar voice recognition. The faces and voices of individuals at the children's schools were used as stimuli. The experimental group were impaired relative to the controls on all three tasks. Face recognition and voice recognition correlated significantly with voice-face identity matching, but not with each other, suggesting that the recognition impairments jointly cause the matching impairment. Neither chronological age nor verbal mental age were consistently related to the recognition and matching impairments.

Auditory Perception↗
PubMed1998

The evolving role of submucosal injectables for treating internal sphincteric deficiency.

Each of the previously mentioned materials can be used in procedures performed on an outpatient basis using sedation and local anesthesia. Teflon usually requires general anesthesia. None of these materials, however, should be used in acute conditions involving cystitis, urolithiasis, or infection. Table 4 summarizes the postoperative care after a bulking agent injection. There are obvious advantages to using injectable materials for ISD, one of which is that the outpatient procedure is usually done under local anesthesia. It does not have the risks inherent in open surgical procedures like slings or artificial sphincters, and it causes minimal increase of urethral resistance to detrusor-generated micturition force. Such procedures are obviously easier and faster to perform with less cost and rapid recovery followed by a return to regular activity within 48 hours. In conclusion, injection therapy for urinary incontinence is appropriate, but the most effective substance has probably not yet been determined.

Collagen↗
PubMed1997

Influenza among hospitalized adults with leukemia.

Influenza is one of the most important respiratory diseases of mankind, yet scant data exist concerning the frequency and clinical course of influenza in severely immunocompromised adults. From October 1993 to September 1994, we cultured the respiratory secretions of all adults with leukemia who were hospitalized with an acute respiratory illness at The University of Texas M.D. Anderson Cancer Center in Houston. During a 9-week period from 29 November 1993 to 29 January 1994, influenza virus type A (H3N2) was isolated from 15 (33%) of these 45 hospitalized adults. Twelve (80%) of the cases of influenza were associated with pneumonia, and four patients (33%) with pneumonia died. Patients who died tended to have received chemotherapy more recently and to be more myelosuppressed. Autopsy examination in two cases revealed histopathologic changes consistent with viral pneumonia. During community outbreaks, influenza is a frequent cause of serious respiratory disease in hospitalized adults with leukemia. Effective prophylactic and therapeutic regimens need to be defined for immunocompromised patients.

Adult↗
PubMed1997

Can young people with autism refer to knowledge states? Evidence from their understanding of "know" and "guess".

A number of studies have reported that most individuals with autism have difficulty in attributing mental states. The primary aim of the present study was to compare the ability of children with autism to refer to knowledge states with that of mainstream school children and children with Down's syndrome. The second aim was to investigate the role of verbal mental age in referring to knowledge states. The third aim was to compare the ease with which the children referred to their own mental state and to that of others. The results suggest that some individuals with autism are able to attribute knowledge to themselves and others but that they need to have higher verbal skills than is necessary in normal individuals. The level of language skill predicted the performance of the individuals with autism, but not that of the children in the other groups. There was no good evidence that referring to one's own mental states was easier than referring to another person's, a finding which supports representational theory rather than the simulationist position.

Adolescent↗
PubMed1996

Management of an outbreak of tuberculosis in a small community.

OBJECTIVE: To investigate an outbreak of tuberculosis, determine the number of active cases and infections, and examine efforts to control the spread of disease. SETTING: A small town in Maine, in which no cases of tuberculosis had been reported in the previous 3 years. DESIGN: Epidemiologic investigation of an outbreak of tuberculosis infection and disease. MEASUREMENTS: A patient with an active case of tuberculosis was defined as a resident of the town or the surrounding area or an employee of the local shipyard who had a culture of sputum or tissue that was positive for Mycobacterium tuberculosis between June 1989 and May 1992. A case of tuberculous infection was defined as a positive tuberculin skin test result in a person with no previous positive test result. RESULTS: 21 active cases of tuberculosis occurred among shipyard workers and persons residing in the affected community between 1989 and 1992. One patient was the source of the outbreak; 8 months lapsed between the onset of this patient's illness and appropriate diagnosis and treatment. The M. tuberculosis strains isolated from this patient and from six other patients belonged to phage type I, auxiliary 14. All isolates were susceptible to drug treatment. Of 9898 persons who were tested, 697 (7%) were newly infected. Because isoniazid prophylaxis was not routinely offered to infected persons older than 35 years of age, only 341 (49%) infected persons completed isoniazid prophylaxis. CONCLUSIONS: Many secondary cases of tuberculosis occurred throughout this small Maine community because of delayed diagnosis and treatment of the source patient, delayed outbreak investigation, and failure to promote isoniazid prophylaxis to all persons infected during the outbreak. Aggressive efforts to identify persons with new infection are of limited value in controlling tuberculosis unless they are accompanied by an equally aggressive use of isoniazid prophylaxis.

Adult↗
PubMed1996

Effect of transvaginal stimulation in the treatment of detrusor instability.

INTRODUCTION: Early research on implantable electrodes for transvaginal stimulation had high rates of complications and mechanical failures. Today's nonimplantable devices are safe for short-term or long-term use. This study evaluated an intermittent short-term transvaginal stimulation program for treatment of bladder overactivity. METHODS: Fifteen women who ranged in age from 22 to 96 years and had bladder instability were enrolled into this noncontrolled, open, clinical evaluation program. Six to 10 biweekly office sessions were followed by use of a home unit twice daily for approximately 6 weeks. RESULTS: Results were based on patients' voiding diaries. All 15 completed the study, and 73% were satisfied with the results. On pretrial urodynamic examination nine patients had sensory urgency, and six patients had involuntary contractions. All tolerated therapy without side effects. Two women had slight vaginal discomfort because of vaginal narrowing. Urinary frequency, urgency, and nocturia were significantly decreased. Seven women reported 75% or more improvement; four women reported 50% to 75% improvement. Three women required a second office treatment series. DISCUSSION: The results of this study support findings of previous researchers, although the follow-up time frame of the study was short. Most of these patients (N = 11 of 15) wished to continue transvaginal stimulation. When three women discontinued home treatments, symptoms recurred in 1 to 3 months. The exact cause is unclear, but scar tissue as a result of previous pelvic operations may have contributed to the problem. The second course of treatment had positive results. Intermittent therapy in these cases is recommended. Transvaginal stimulation should be considered for treatment for urinary incontinence because the device is easily used and adjusted by the patient, patients may be very compliant, and results are satisfactory and at least similar to those attained with drug therapy.

Adult↗
PubMed1995

Generativity in the play of young people with autism.

Examines the ability of young people with autism to generate ideas for play. Young people with autism, children with learning difficulties, and younger normal children were asked to generate 12 different actions and follow 12 instructions with a car and a doll. The young people with autism were impaired, relative to the controls, at generating original actions with the car, but were as able as the controls to follow the instructions. However, the young people with autism were not impaired at generating original actions with the doll. All three groups produced similar amounts of symbolic play. Possible explanations for the difference in results for the two toys are discussed.

Adolescent↗
PubMed1995

A prospective comparison of Synthetic Serum Substitute and human serum albumin in culture for in vitro fertilization-embryo transfer.

OBJECTIVE: To compare the efficacy of a globulin-containing protein source, Synthetic Serum Substitute (Irvine Scientific, Santa Ana, CA) and human serum albumin (HSA) in the early culture of human oocytes and embryos. DESIGN: Oocytes from 31 consecutive IVF cycles were assigned alternately to dishes containing human tubal fluid (HTF) and either Synthetic Serum Substitute or HSA as the protein source. Each semen sample was split for processing in Synthetic Serum Substitute or HSA. Sperm processed in Synthetic Serum Substitute was added to oocytes cultured in Synthetic Serum Substitute, and sperm processed in HSA was added to oocytes cultured in HSA. After determination of fertilization, zygotes were placed in HTF containing the same protein supplement. Before transfer, the embryos were graded morphologically. MAIN OUTCOME MEASURES: Occurrence of normal fertilization and embryo quality as assessed by morphological grading. RESULTS: There was no significant difference in the occurrence of fertilization or in embryo morphological quality between oocytes cultured in Synthetic Serum Substitute as compared with HSA. CONCLUSIONS: The use of a globulin-containing protein source in culture for IVF-ET did not improve the fertilization rate or embryo quality. Our design did not allow for demonstration of an effect on pregnancy rate.

Adult↗
PubMed1995

Respiratory syncytial virus pneumonia in hospitalized adult patients with leukemia.

Respiratory syncytial virus (RSV) has been demonstrated to be an important cause of life-threatening pneumonia in adult bone marrow transplant recipients; however, its role in other immunocompromised adults has not been defined. We prospectively studied all adult patients with leukemia who were hospitalized at M. D. Anderson Cancer Center (Houston) during a 1-year period (November 1993 through October 1994). During a 19-week period when RSV was prevalent in the community, it was isolated from 9 (10%) of 87 patients with leukemia who developed an acute respiratory illness. In 6 (75%) of 8 patients with profound chemotherapy-induced myelosuppression, the RSV infection was complicated by pneumonia, with an 83% mortality rate. RSV appears to be an important cause of severe and often fatal pneumonia in myelosuppressed patients with leukemia.

Acute Disease↗
PubMed1995

Galactosemia: clinical features, diagnosis and management. A case report.

The case report and discussion presented here were prepared in response to legislation in Louisiana which requires that the Dept of Health and Hospitals establish a program to inform physicians and hospitals of the current medical standards for the diagnosis, clinical management, and recognition of galactosemia. Classical galactosemia is an inborn error of galactose metabolism caused by a deficiency of galactose-1-phosphate uridryl transferase. It is inherited as an autosomal recessive trait and its estimated occurrence is 1/60,000. The presenting symptoms which include vomiting, diarrhea, jaundice, and failure to thrive result from the ingestion of foods containing galactose--breast milk and formulas containing cow's milk. Although some states routinely screen all newborns for galactosemia, the results of the newborn screening are often not available before the infant presents with symptoms. Early recognition and immediate withdrawal of galactose from the diet can prevent serious morbidity and mortality. There is significant clinical variability and not all infants present with typical acute manifestations of the disease.

Diagnosis, Differential↗
PubMed1994

The value of the vaginal pack test in large cystoceles.

To detect possible stress urinary incontinence associated with but masked by large cystoceles protruding through the vaginal orifice, a vaginal pack test was done in conjunction with video fluoro-urodynamic studies. Sixteen female patients with large cystoceles did not demonstrate stress urinary incontinence on clinical examination and were included in this study. Additionally, 10 healthy female volunteers underwent the same test to study the effect of a vaginal pack on urethral dynamics. The vaginal pack revealed the presence of stress urinary incontinence in 11 patients (69%): 3 (19%) with type II (vesicourethral hypermobility) and 8 (50%) with type III (internal sphincteric deficiency). After insertion of the vaginal pack, urodynamic studies showed that the closing proximal urethral pressure in patients with stress urinary incontinence was significantly lower than in continent patients (p < 0.05). No significant change in urethral pressures was noted in volunteer subjects after vaginal pack insertion. Fluoroscopy showed kinking of the posterior urethra and enlargement of the most dependent portion of the cystocele, that is the lower half of the hourglass image. Our study suggests that the mechanisms of continence in these patients are multifactorial, including urethral kinking, urethral compression and pressure dissipation. The vaginal pack test is easy to perform, increases visualization of the vesicourethral unit when used with fluoroscopy, and can aid in the selection of patients who would benefit from anti-incontinence surgery and/or cystocele repair.

Adult↗
PubMed1994

Validational data on the Warwick Symbolic Play Test.

This paper examines the validity of a recently developed test of symbolic play. The Warwick Symbolic Play Test (WSPT) was administered to 60 normal children, 30 girls and 30 boys aged 3-6 years. In addition the children's expressive and receptive language skills were assessed using the Renfrew Action Picture Test and the British Picture Vocabulary Scale respectively. Significant correlations were found between scores obtained on the play test and both language measures. Exploratory statistics indicated that, when age was taken into account, partial correlations between play and language remained moderate. Further analysis of the results also suggested that the relationship between play and language ability as measured by the tests was stronger for the younger children in the sample than for the older children. These results suggest that the WSPT may indeed be a useful assessment instrument, in conjunction with measures of functional play, for assessment of language ability, diagnosis and possible treatment of language disorders, especially for children under the developmental age of 5 years.

Child, Preschool↗
PubMed1993

Clinical experience with multiagent intravesical therapy in interstitial cystitis patients unresponsive to single-agent therapy.

A total of 25 patients with the diagnosis of interstitial cystitis (IC) were involved in this study. All patients had been previously diagnosed with interstitial cystitis and had received treatment with single intravesical agents. Patients were divided into two groups according to their bladder capacity. The bladder capacity was > 350 ml in group I patients and < 350 ml in group II patients. For our study, dimethylsulfoxide (DMSO), methylprednisolone, and heparin sulfate were given every week for a total of 6 weeks. When symptoms recurred, supportive oral pharmacotherapy consisting of anticholinergics and/or tricyclic antidepressants was given. Under anesthesia, patients in group I showed a 99% increase in their bladder capacity; whereas those in group II showed an increase of only 19%. Cystoscopically, Hunner's ulcers were present in 60% of the group II patients but were seen in only 5% of the group I patients. Histopathological examination showed that the inflammatory changes were more frequent and severe in group II than in group I. Mast-cell hyperplasia was present in 100% of the patients in group II, versus only 61% of those in group I. A total of 23 patients (92%) achieved an initial remission averaging 8.1 months. In all, 9 patients (35%) had 1 or more relapses, and all achieved a subsequent remission averaging 8 months. By this combined multiagent approach, the majority of patients with IC obtained relief from their incapacitating symptoms and were socially rehabilitated.

Administration, Intravesical↗
PubMed1993

The health and wellbeing of informal caregivers: a review and study program.

Informal caregivers are the families and other unpaid caregivers in the home who support people of all ages with severe and chronic mental or physical disabilities. Home care of this sort has been increasing over the past 30 years because of the reduced number of beds in hospitals and nursing homes and increased outpatient and community care. Moreover, with an aging population and increasing rates of disability, the demand for family caregiving will continue to rise. This has important implications for the development of health, community service and social policy. At the same time, however, very little is known about the impact such changes are having on the caregivers of various ages and in various circumstances. The Victorian Health Promotion Foundation is funding a research and intervention program in Melbourne to promote wellbeing and prevent ill-health in caregivers.

Caregivers↗