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Biomedical subjects

V Lewis

Publications and source records attributed to V Lewis.

At least 19 recordsLinked to original sources
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↗
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↗
PubMed1992

Unfamiliar face recognition in relatively able autistic children.

Two experiments were carried out assessing autistic children's recognition, discrimination, and fixation of unfamiliar faces and unfamiliar buildings. The experiments showed that (i) unfamiliar face recognition is impaired relative to normal peers, non-verbal ability matched and verbal ability matched controls. Relative to verbal ability matched controls (ii) recognition of buildings is normal; (iii) there is an enhanced discrepancy between face discrimination and buildings discrimination, in favour of buildings; and (iv) fixation is normal. Analysis of the results suggests that impaired face recognition does not result from impaired attention or discrimination.

Adolescent↗
PubMed1992

The assessment of symbolic play in young children: a prototype test.

In this paper it is argued that assessing symbolic play (defined as one object substituting for another, a property being attributed to an object which it does not have or an absent object being referred to as if present) is particularly useful for young children in whom language and/or play is not developing normally. A new test of symbolic play is described which assesses the child's ability to substitute her- or himself, a teddy or a non-representational object such as a piece of material for another object, to attribute a property to her- or himself or a teddy, and to refer to an absent object used by her- or himself or a teddy. The play may be modelled or instructed or the child may produce examples of her or his own. Some preliminary results from a group of 43 children are reported. It is concluded that this new test of symbolic play will provide clinicians working with children whose language and/or play is impaired with information of value in reaching a diagnosis and in understanding immediate treatment needs.

Child↗
PubMed1990

Rabbit alveolar beta-adrenergic receptors increase with gestational age.

Pulmonary beta-adrenergic receptors, which mediate the actions of endogenous catecholamines, increase before birth, an important step in pulmonary maturation. This increase, which occurs primarily in the alveoli, may be hastened by corticosteroids. However, because the lung is composed of more than 40 cell types, we asked whether the normal distribution of beta-adrenergic receptors changes with gestational age in a way that seems physiologically relevant. We compared lungs from fetal rabbits at 26 and 31 days' gestation with lungs from adult rabbits by autoradiography with 125iodocyanopindolol, a beta-adrenergic antagonist. While the total silver grain concentration increased during gestation, the greatest proportional increase occurred in the alveoli. We conclude that pulmonary beta-adrenergic receptor concentration increases during gestation and that this increase is most dramatic for alveoli. This pattern is consistent with that previously observed after treatment of fetal rabbits in utero with corticosteroids.

Animals↗
PubMed1990

Restriction fragment length polymorphism analysis of HLA haplotypes in families with type I diabetes mellitus.

HLA Class II polymorphisms were analysed in 27 families with at least one Type I diabetic proband using Southern blotting technique according to 10th Histocompatibility Workshop Standards. The probes used were DRB, DQA1, DQB1 and DOB. We have studied 108 haplotypes and performed segregation analysis with HLA serology and restriction fragment length polymorphism (RFLP) data and compared "affected" with "non-affected" haplotypes (not inherited by IDDM patients). RFLPs correlated well with DR and DQ serology and detected additional polymorphisms. In particular, DQB polymorphism analysis showed segregation of the DQw3 splits with 88.5% of the DR4 affected haplotypes bearing the DQw3.2 split (now DQw8) and 11.5% the DQw3.1 split (now DQw7) while in the non-affected DR4 haplotypes 33.3% were DQw3.2 and 66.6% were DQw3.1. Haplotype analysis showed that DR4-DQw3.2 was in strong linkage with the U fragment (2.1 kb Taq I) of DQA2 (DX alpha) and with the L fragment (5.4 kb BamH I) of DOB. This study confirms previous observations of DQB polymorphisms in heterozygous IDDM patients, supports the protective effect of DQw3.1 (DQw7) against the development of the disease and demonstrates the importance of DQw3.2 (DQw8) for susceptibility to Type I diabetes.

Diabetes Mellitus, Type 1↗
PubMed1990

Hand dominance of parents and other relatives of autistic children.

Hand preferences of 219 mothers and 186 fathers of autistic children were assessed using the Annett Handedness questionnaire. Subgroups of 54 mothers and 57 fathers with a family history of language-related developmental disorders were identified. Parents also reported the handedness of other relatives. Mothers (but not fathers) in the main group were significantly more likely to be consistently right-handed than females in the general population, but this was not specifically associated with a family history of language problems. There was no evidence of an increased incidence of consistent left-handedness in either the whole group of parents or the subgroups. Reported handedness of other relatives showed no abnormal distribution in relation to a comparison group. The findings are discussed in relation to theories about genetic factors in language-related developmental disorders in general, and autism in particular.

Adult↗
PubMed1990

Retention of intrauterine fetal bone increases menstrual prostaglandins.

Intrauterine retention of fetal bone is a rare complication of abortion that can cause secondary infertility by an unknown mechanism. We report such a case in which menstrual fluid prostanoids were measured to elucidate the possible pathophysiology. The pattern of prostanoid increases was similar to that seen in intrauterine device users.

6-Ketoprostaglandin F1 alpha↗
PubMed1989

The t complex polypeptide 1 (TCP-1) is associated with the cytoplasmic aspect of Golgi membranes.

The t complex polypeptide 1 (TCP-1) is a protein of unknown function expressed in large amounts during spermatogenesis. Rat monoclonal antibodies recognizing TCP-1 have been prepared and used to immunoprecipitate and Western blot a 57 kd protein from germ cell and tissue culture cell extracts. In tissue culture cells, indirect immunofluorescent localization of antigen indicated a perinuclear distribution similar to that of the Golgi apparatus. Analysis of the TCP-1 distribution in tissue culture cells showed that the polypeptide was associated with the cytoplasmic aspect of membranes of the trans-Golgi network (TGN). The distribution in spermatids suggested that TCP-1 was localized to structures often associated with the developing acrosome. The TCP-1 antigenic epitopes are highly conserved, allowing the protein to be identified in cells across a wide variety of vertebrate species and tissues. These experiments suggest that TCP-1 may be essential for transport of proteins through the exocytic pathway in all cells and required in large amounts for acrosome formation in developing spermatids.

Acrosome↗