Biomedical subjects
Publications and source records attributed to C M Lewis.
During major breast surgery, we have achieved superior results by securing a dermal flap to the chest wall. This technique has been used successfully for the past three years with improvement in breast contour, prevention of ptosis, and less pronounced scarring than is produced by techniques of the past.
We report our experiences in 100 consecutive face lifts done in a well-equipped office operating room, and we believe the results answer the question about the safety of face lifts being done in this manner in a carefully screened population. With the application of our preoperative criteria for patient selection, the complication rate in these outpatients compares favorably with the reported rates in inpatient series of face lifts. Patient satisfaction has been higher, we feel.
A radioimmunoassay for measuring levels of lymphocyte autoantibody in chronic lymphocytic leukaemia (CLL) has been developed. Antibody in the form of crude IgG was extracted from patients' sera and iodinated. The assay utilizes its cross-reactivity with other CLL cells. Levels were measured in 23 patients. The results show that an inverse relationship exists between the quantity of circulating CLL autoantibodies and the number of mouse red blood cell rosetting lymphocytes (M cells). The preliminary findings do not correlate with disease activity although it is our impression that patients who are maintaining higher levels of autoantibody and fewer M-rosetting cells have nonprogressive disease.
The fluorescein test is a useful ancillary procedure for predicting the viability of breast flaps in reconstructive procedures after subcutaneous mastectomy or radial mastectomy.
Using a fluorescent technique intracellular immune complexes were found in the peripheral leucocytes in all of 12 patients with myelofibrosis studied. Fluorescent cells varied from 12% to 81%; with no relation to the total white count or any obvious clinical finding. Three of the patients with severe refractory anaemia benefited from immunosuppressive therapy.
In chronic lymphocytic leukaemia a factor in patients' serum enhances the in vitro viability of the abnormal cells and this has been identified as an antibody. The activity of this factor can be removed by interaction with anti-immunoglobulin and by ammonium sulphate precipitation with a degree of saturation in excess of 46%. Cohn fractionation and chromatography with A-50 Sephadex show that the factor is not a complex but an immunoglobulin. No activity is removed after reaction of sera with 2-mercapto-ethanol and di-thiothreitol. The evidence therefore suggests that a gamma-G immunoglobulin is involved. Concentrated washings from the leukaemic cells behave in exactly the same way as patients' sera and activity is retained in the same fraction during precipitation and purification procedure. The extensive cross-reactivity of the sera suggests a common chronic lymphatic leukaemic antibody and it is considered that an active autoimmune response may be an integral part of the disease.
We compared results with three commercial folate radioassay kits [Bio-Rad, New England Nuclear (NEN), and RIA Products] with those by microbiological assay for more than 200 samples of human serum and whole blood. All but one kit (NEN) compared favorably with the microbiological assay for serum samples, although there were notable diagnostic discrepancies. Two kits (NEN and Bio-Rad) were tested on whole-blood samples; both yielded values significantly higher than those by microbiological assay. The frequency distributions of erythrocyte folate data differed strikingly between the two kits; the NEN method yielded a much narrower range of normal values than did either the Bio-Rad or the microbiological assay. Radioassay kits appear to be suitable diagnostic agents for serum folate, if the behavior of a particular kit is investigated thoroughly before its routine use. However, the diagnostic value of radioassays of erythrocyte folate needs to be validated.
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A fluorescein-labelled anti-human immunoglobulin was used to demonstrate that peripheral blood from patients with myelofibrosis had a high proportion of phagocytic cells containing fluorescent immune complexes. Cells from patients with other myeloproliferative diseases (either chronic myeloid leukaemia or polycythaemia rubra vera) did not show similar intracellular immune complexes. Serum from patients with myelofibrosis incubated with polymorphs from healthy subjects caused the appearance of inclusions similar to those found when the patients' own cells were used, the healthy phagocytes apparently engulfing complexes from the patients' sera. The presence of platelets or complement did not alter the incidence of intracellular fluorescence. These tests may help in the diagnosis of myelofibrosis and may also be valuable in recognising the onset of this condition in patients with polycythaemia rubra vera.
Direct labelling of cell surface protein with 125I has enabled measurements to be made of lymphocyte membrane turnover. In CLL cells this is evidently much retarded in comparison with normal lymphocytes and it was thought that slow replacement of cell surface proteins might be responsible both for lack of membrane mobility and poor immunological responses. Serum from CLL patients has been found to enhance viability of the leukaemic cells in culture and the interaction of these serum factors with the CLL cell membrane gives rise to rapid replacement of surface proteins. Thus the rate of membrane turnover in vivo would be comparable with that of normal lymphocytes. Lack of cell-surface mobility and poor membrane biosynthesis can not be held responsible for poor immunological activity in vivo and it is suggested that autoimmune antibodies binding to the surface of CLL cells may spatially inhibit activation by ligands.
Iodination of surface membrane protein has allowed the dynamics of lymphocyte surface membrane protein to be examined. A comparison has been made between the rate of membrane turnover in fresh peripheral blood lymphocytes and lymphocytes in other states. When receptor redistribution is inhibited with high concentrations of mitogens, 'rigidification' of the membrane occurs and protein turnover is very much reduced. Loss of surface membrane protein is also much slower in lymphocytes which have been stimulated with mitogens and are undergoing active DNA synthesis. It is thought that these observations may relate to immunological inactivity and may have implications for pathological unresponsiveness.
Nuclear material can produce inhibition or stimulation of healty leucocytes under different experimental conditions, Reactivity could not be produced in cultures using intact nuclei and allogeneic lymphocytes. The effect of nuclear and cytoplasm fractions was compared with that of whole cells on intact healthy lymphocytes. The HLA activity in the individual fractions was assessed. Stimulation was produced by certain nuclear and cytoplasmic fractions and these were closely related to the peaks of HLA activity. The response to these fractions showed less activity than that achieved in conventional one way MLC tests.
Guinea-pigs sensitized by subcutaneous injection of chronic lymphatic leukaemia (CLL) cells combined with Bacillus Calmette-Guérin (BCG) displayed good skin reacitons 24 and 48 h after challenge with CLL cells. Equally good responses were also demonstrated using nuclei from the leukaemic cells in combination with BCG. These reactions were significantly greater than those produced in the same manner but without BCG. Sera form the animals were examined for the presence of antibodies against CLL cells by cytotoxicity and immunofluorescence techniques. Only samples from guinea-pigs innoculated with CLL cells were found to contain significant antibodies. Histological examination showed that whereas leukaemic cells persisted at the sensitizing injection site leukaemic cell nuclei could not be visualized. It is suggested that because leukaemic cell nuclei in combination with BCG are able to induce good skin reactivity without provoking a vigorous humoral antibody response they may have possible advantages over leukaemic cells when used for immunotherapy.